Provider Demographics
NPI:1750442760
Name:KELLEY, LIVIA MARIE (MA)
Entity Type:Individual
Prefix:MS
First Name:LIVIA
Middle Name:MARIE
Last Name:KELLEY
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 1:1152 COMMONWEALTH AVE
Mailing Address - Street 2:#51
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134
Mailing Address - Country:US
Mailing Address - Phone:207-752-3653
Mailing Address - Fax:
Practice Address - Street 1:37 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-580-4691
Practice Address - Fax:508-588-5751
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health