Provider Demographics
NPI:1477198984
Name:DOLLY, KESHELLE (MA)
Entity Type:Individual
Prefix:
First Name:KESHELLE
Middle Name:
Last Name:DOLLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:KESHELLE
Other - Middle Name:
Other - Last Name:DOLLY-RICHARDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:85 MORTON VILLAGE DR APT 311
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2424
Mailing Address - Country:US
Mailing Address - Phone:617-939-3321
Mailing Address - Fax:
Practice Address - Street 1:780 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3908
Practice Address - Country:US
Practice Address - Phone:857-225-6175
Practice Address - Fax:617-469-8595
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YS0200X
MA12888-MH-CC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool