Provider Demographics
NPI:1750168993
Name:STOCKWELL, KELLI
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:STOCKWELL
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 1:72 TRILBY AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1086
Mailing Address - Country:US
Mailing Address - Phone:413-885-8635
Mailing Address - Fax:
Practice Address - Street 1:220 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-5900
Practice Address - Country:US
Practice Address - Phone:413-885-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst