Provider Demographics
NPI:1992386544
Name:KELLEY M GUILFOIL-ZINKEVICH, LICSW, LLC
Entity Type:Organization
Organization Name:KELLEY M GUILFOIL-ZINKEVICH, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUILFOIL-ZINKEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-494-5118
Mailing Address - Street 1:100 JUNE ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2959
Mailing Address - Country:US
Mailing Address - Phone:508-494-5118
Mailing Address - Fax:
Practice Address - Street 1:100 JUNE ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2959
Practice Address - Country:US
Practice Address - Phone:508-494-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)