Provider Demographics
NPI:1467525279
Name:ALLEY, KELLY MACDONALD (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MACDONALD
Last Name:ALLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BUTTERCUP LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01560-1247
Mailing Address - Country:US
Mailing Address - Phone:508-497-8989
Mailing Address - Fax:
Practice Address - Street 1:10 ASYLUM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2203
Practice Address - Country:US
Practice Address - Phone:508-478-6888
Practice Address - Fax:508-478-9042
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1136651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical