Provider Demographics
NPI:1295119345
Name:DUBE, KELLI ANN
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:ANN
Last Name:DUBE
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 1:1 VERNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03047
Mailing Address - Country:US
Mailing Address - Phone:603-547-3311
Mailing Address - Fax:
Practice Address - Street 1:1 VERNEY DRIVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:NH
Practice Address - Zip Code:03047
Practice Address - Country:US
Practice Address - Phone:603-547-3311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH113197103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool