Provider Demographics
NPI:1659578649
Name:CARTER-MAYNARD, KELLY (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:
Last Name:CARTER-MAYNARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 HOLLYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2606
Mailing Address - Country:US
Mailing Address - Phone:604-803-2748
Mailing Address - Fax:
Practice Address - Street 1:779 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1674
Practice Address - Country:US
Practice Address - Phone:860-480-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional