Provider Demographics
NPI:1245573690
Name:KELLS, DAVID BAKER (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BAKER
Last Name:KELLS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-1440
Mailing Address - Country:US
Mailing Address - Phone:413-222-0647
Mailing Address - Fax:
Practice Address - Street 1:25 BANK ROW ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3599
Practice Address - Country:US
Practice Address - Phone:413-222-0647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1174361041C0700X
VT089.00662231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical