Provider Demographics
NPI:1184215485
Name:WILLIAMS, KELLY LYN (LNA, BAPSY)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LNA, BAPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 UPLAND RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1926
Mailing Address - Country:US
Mailing Address - Phone:603-973-3781
Mailing Address - Fax:
Practice Address - Street 1:5 CEDAR RIDGE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3284
Practice Address - Country:US
Practice Address - Phone:508-339-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician