Provider Demographics
NPI:1538644596
Name:KIELSON, LAURA ELLEN
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:ELLEN
Last Name:KIELSON
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 1:500 UNICORN PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3377
Mailing Address - Country:US
Mailing Address - Phone:857-282-3255
Mailing Address - Fax:781-994-7633
Practice Address - Street 1:500 UNICORN PARK DR
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801
Practice Address - Country:US
Practice Address - Phone:857-282-3255
Practice Address - Fax:781-994-7633
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10310171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical