Provider Demographics
NPI:1861474066
Name:KELLEY, MARY MORRIS (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MORRIS
Last Name:KELLEY
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 1:33 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:RI
Mailing Address - Zip Code:02871-1220
Mailing Address - Country:US
Mailing Address - Phone:401-683-4331
Mailing Address - Fax:508-996-5474
Practice Address - Street 1:384 COUNTY ST
Practice Address - Street 2:THE GILBERT RUSSELL HOUSE, 2ND FL
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4980
Practice Address - Country:US
Practice Address - Phone:508-996-5418
Practice Address - Fax:508-996-5474
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1103741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2182448OtherCIGNA
MA460410OtherTUFTS HEALTH PLAN
MAPO8093OtherBC/BS OF MASSACHUSETTS
RI26547-0OtherBC/BS OF RHODE ISLAND
RI410491OtherOTHER RI BC/BS PLANS
RI26547-0OtherBC/BS OF RHODE ISLAND