Provider Demographics
NPI:1154451904
Name:KELLEY, KAREN LM
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LM
Last Name:KELLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KELHAM LANE
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-0235
Mailing Address - Country:US
Mailing Address - Phone:207-338-6104
Mailing Address - Fax:
Practice Address - Street 1:143 HIGH ST
Practice Address - Street 2:SUITE 25
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6548
Practice Address - Country:US
Practice Address - Phone:207-338-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor