Provider Demographics
NPI:1851582720
Name:DUNN, KELLY JANE RILEY (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JANE RILEY
Last Name:DUNN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S HUNTINGTON AVE
Mailing Address - Street 2:MAIL STOP 117
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130-4817
Mailing Address - Country:US
Mailing Address - Phone:857-364-6555
Mailing Address - Fax:857-364-6664
Practice Address - Street 1:150 S HUNTINGTON AVE
Practice Address - Street 2:MAIL STOP 117
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-4817
Practice Address - Country:US
Practice Address - Phone:857-364-6555
Practice Address - Fax:857-364-6664
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA111971104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker