Provider Demographics
NPI:1942389382
Name:KELLY, DEBORAH ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-5903
Mailing Address - Country:US
Mailing Address - Phone:978-537-1835
Mailing Address - Fax:
Practice Address - Street 1:1205 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-5903
Practice Address - Country:US
Practice Address - Phone:978-537-1835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10162441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA005527OtherVALUE OPTIONS
MA717551OtherTUFTS HEALTH PLAN ID
MASO28275OtherCHAMPUS
MA55449731OtherUNITED BEHAVIORAL HEALTH
MA171035OtherMAGELLAN
MA7104711OtherBLUE CROSS BLUE SHIELD
MA717551OtherTUFTS HEALTH PLAN ID