Provider Demographics
NPI:1396121075
Name:QUIGLEY, KELLI (LICSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:QUIGLEY
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 1:8 HALON TER
Mailing Address - Street 2:
Mailing Address - City:EAST LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-3201
Mailing Address - Country:US
Mailing Address - Phone:413-540-6047
Mailing Address - Fax:
Practice Address - Street 1:123 DWIGHT RD # E2
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1993
Practice Address - Country:US
Practice Address - Phone:413-540-6047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health