Provider Demographics
NPI:1023507837
Name:KELLY, HUGH MICHAEL (LCSW)
Entity type:Individual
Prefix:
First Name:HUGH
Middle Name:MICHAEL
Last Name:KELLY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:ME
Mailing Address - Zip Code:04929-0035
Mailing Address - Country:US
Mailing Address - Phone:207-217-0340
Mailing Address - Fax:
Practice Address - Street 1:50 TROY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:ME
Practice Address - Zip Code:04929-3015
Practice Address - Country:US
Practice Address - Phone:207-217-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC153791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical