Provider Demographics
NPI:1790077618
Name:KELLEY, ERIN (BS)
Entity Type:Individual
Prefix:MS
First Name:ERIN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-3417
Mailing Address - Country:US
Mailing Address - Phone:508-463-5097
Mailing Address - Fax:
Practice Address - Street 1:88 DEAN ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-3417
Practice Address - Country:US
Practice Address - Phone:508-463-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator