Provider Demographics
NPI:1649563735
Name:MCKELVEY, CATHERINE (MA, CAS)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MCKELVEY
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHEPARD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7624
Mailing Address - Country:US
Mailing Address - Phone:203-556-8829
Mailing Address - Fax:
Practice Address - Street 1:16 SHEPARD ST APT 1
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7624
Practice Address - Country:US
Practice Address - Phone:203-556-8829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4041880103TS0200X
MA453081103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool