Provider Demographics
NPI:1306372669
Name:KELLY, JAIME-ROSE (LCMHC)
Entity Type:Individual
Prefix:
First Name:JAIME-ROSE
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-4729
Mailing Address - Country:US
Mailing Address - Phone:603-444-5358
Mailing Address - Fax:603-444-0145
Practice Address - Street 1:29 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4729
Practice Address - Country:US
Practice Address - Phone:603-444-5358
Practice Address - Fax:603-444-0145
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health