Provider Demographics
NPI:1326793381
Name:KELLY MCADAMS, LICSW, LLC
Entity Type:Organization
Organization Name:KELLY MCADAMS, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-312-2026
Mailing Address - Street 1:867 BOYLSTON ST FL 5-1170
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2774
Mailing Address - Country:US
Mailing Address - Phone:617-312-2026
Mailing Address - Fax:
Practice Address - Street 1:867 BOYLSTON ST FL 5-1170
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2774
Practice Address - Country:US
Practice Address - Phone:617-312-2026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health