Provider Demographics
NPI:1164603718
Name:CLADY-GIRAMMA, KELLY A (LIC AC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:CLADY-GIRAMMA
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CONCORD PKWY
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7345
Mailing Address - Country:US
Mailing Address - Phone:413-637-4400
Mailing Address - Fax:
Practice Address - Street 1:ACUPUNCTURE DEPT., CANYON RANCH
Practice Address - Street 2:165 KEMBLE ST.
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240
Practice Address - Country:US
Practice Address - Phone:413-637-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist