Provider Demographics
NPI:1689981680
Name:KELLY, NOELLE KRISTIN (MA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:KRISTIN
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2204
Mailing Address - Country:US
Mailing Address - Phone:914-466-4273
Mailing Address - Fax:
Practice Address - Street 1:356 FISHER ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2204
Practice Address - Country:US
Practice Address - Phone:914-466-4273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health