Provider Demographics
NPI:1609197441
Name:MARTELL, KELLY J (LICSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:MARTELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:CASICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:7 WORKS WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878-1639
Mailing Address - Country:US
Mailing Address - Phone:603-692-3166
Mailing Address - Fax:603-692-3168
Practice Address - Street 1:255 ROUTE 108
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-1543
Practice Address - Country:US
Practice Address - Phone:603-692-3166
Practice Address - Fax:603-692-3168
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH19791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical