Provider Demographics
NPI:1417730078
Name:KELLY, DEANA
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:11 MASSASOIT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2517
Mailing Address - Country:US
Mailing Address - Phone:781-366-8986
Mailing Address - Fax:
Practice Address - Street 1:11 MASSASOIT AVE # 1
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2517
Practice Address - Country:US
Practice Address - Phone:781-366-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical