Provider Demographics
NPI:1225081508
Name:KELLEY, MELISSA A (LMHC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SEVILLA AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-3032
Mailing Address - Country:US
Mailing Address - Phone:401-921-0997
Mailing Address - Fax:
Practice Address - Street 1:33 COLLEGE HILL RD
Practice Address - Street 2:SUITE 30E
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2776
Practice Address - Country:US
Practice Address - Phone:401-821-6070
Practice Address - Fax:401-821-6047
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2190761OtherCIGNA
409279OtherBLUECHIP
21721-9OtherBC/BS OF RI
62-99188OtherUNITED HEALTH CARE