Provider Demographics
NPI:1851519441
Name:KELLY, WILLIAM XAVIER (MA, LMHC, LADC1)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:XAVIER
Last Name:KELLY
Suffix:
Gender:M
Credentials:MA, LMHC, LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 VILLAGE GRN N
Mailing Address - Street 2:SUITE 160
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7761
Mailing Address - Country:US
Mailing Address - Phone:860-324-9720
Mailing Address - Fax:
Practice Address - Street 1:275 MILLWAY
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630-1102
Practice Address - Country:US
Practice Address - Phone:860-324-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000668101YA0400X
CT001149106H00000X
CT001719101YP2500X
MA7274101YM0800X
MA2304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional