Provider Demographics
NPI:1275682379
Name:KELLYBEDARD, PATRICIA ELLEN (MA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELLEN
Last Name:KELLYBEDARD
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 DWIGHT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1700
Mailing Address - Country:US
Mailing Address - Phone:413-567-3427
Mailing Address - Fax:413-567-3207
Practice Address - Street 1:171 DWIGHT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1700
Practice Address - Country:US
Practice Address - Phone:413-567-3427
Practice Address - Fax:413-567-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health