Provider Demographics
NPI:1326280173
Name:KIRSHTEIN, KELLI LYNNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:LYNNE
Last Name:KIRSHTEIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CRANE AVE
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754-1448
Mailing Address - Country:US
Mailing Address - Phone:978-264-4003
Mailing Address - Fax:
Practice Address - Street 1:525 MAIN ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3955
Practice Address - Country:US
Practice Address - Phone:978-264-4003
Practice Address - Fax:978-264-4003
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10224641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical