Provider Demographics
NPI:1437422052
Name:MCCANN, KELLY D (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:D
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:D
Other - Last Name:CROWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 224
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-0224
Mailing Address - Country:US
Mailing Address - Phone:603-788-2288
Mailing Address - Fax:
Practice Address - Street 1:97 MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3063
Practice Address - Country:US
Practice Address - Phone:603-788-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1251103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical