Provider Demographics
NPI:1457846339
Name:DICATO, KELLY F
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:F
Last Name:DICATO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WITHAM ST
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1539
Mailing Address - Country:US
Mailing Address - Phone:617-797-7532
Mailing Address - Fax:
Practice Address - Street 1:83 PINE ST STE 102
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3635
Practice Address - Country:US
Practice Address - Phone:978-717-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst