Provider Demographics
NPI:1154470474
Name:KELLY, KATIE ELIZABETH (MA)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:ELIZABETH
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 EASTBURN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3209
Mailing Address - Country:US
Mailing Address - Phone:516-317-9274
Mailing Address - Fax:
Practice Address - Street 1:27 HOLLIS ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8615
Practice Address - Country:US
Practice Address - Phone:508-935-0769
Practice Address - Fax:508-875-2600
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health