Provider Demographics
NPI:1417260530
Name:KELLEY, DEIRDRE MAY (LICAC)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:MAY
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1537
Mailing Address - Country:US
Mailing Address - Phone:781-449-1280
Mailing Address - Fax:
Practice Address - Street 1:70 DEERFIELD RD
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-1537
Practice Address - Country:US
Practice Address - Phone:781-449-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist