Provider Demographics
NPI:1457977423
Name:REVER, KELLEY KATHLEEN
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:KATHLEEN
Last Name:REVER
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 1:129 CHISWICK RD APT 17
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5315
Mailing Address - Country:US
Mailing Address - Phone:617-987-1773
Mailing Address - Fax:
Practice Address - Street 1:129 CHISWICK RD APT 17
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-5315
Practice Address - Country:US
Practice Address - Phone:617-987-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst