Provider Demographics
NPI:1093180366
Name:KELLEHER, PAUL (LICSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KELLEHER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BLACKSTONE ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4609
Mailing Address - Country:US
Mailing Address - Phone:508-549-5600
Mailing Address - Fax:
Practice Address - Street 1:18 BLACKSTONE ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-4609
Practice Address - Country:US
Practice Address - Phone:508-549-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1044881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical