Provider Demographics
NPI:1407157316
Name:MITCHELL, KELLY LEIGH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LEIGH
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CHAPEL PL
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3130
Mailing Address - Country:US
Mailing Address - Phone:781-235-4950
Mailing Address - Fax:781-235-7176
Practice Address - Street 1:11 CHAPEL PL
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-3130
Practice Address - Country:US
Practice Address - Phone:781-235-4950
Practice Address - Fax:781-235-7176
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical