Provider Demographics
NPI:1144600230
Name:LEAL, KELLY ANN (BA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:LEAL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 N FRONT ST FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-7327
Mailing Address - Country:US
Mailing Address - Phone:508-971-4309
Mailing Address - Fax:
Practice Address - Street 1:98 N FRONT ST FL 3
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-7327
Practice Address - Country:US
Practice Address - Phone:508-264-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator