Provider Demographics
NPI:1205084696
Name:DUCHARME, KELLY LYNN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:DUCHARME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 ELM ST
Practice Address - Street 2:APT 227A
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-8625
Practice Address - Country:US
Practice Address - Phone:860-983-3430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health