Provider Demographics
NPI:1437215951
Name:KELLY, MARTIN J (LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:J
Last Name:KELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JOHN DEMPSEY HOSPITAL
Mailing Address - Street 2:263 FARMINGTON AVENUE, MC-6410
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-6700
Mailing Address - Fax:
Practice Address - Street 1:JOHN DEMPSEY HOSPITAL
Practice Address - Street 2:263 FARMINGTON AVENUE, MC-6410
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional