Provider Demographics
NPI:1831653666
Name:HUTTON, KELLY S (LICSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:HUTTON
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 1:1 GROVE HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01521-2611
Mailing Address - Country:US
Mailing Address - Phone:631-220-4432
Mailing Address - Fax:
Practice Address - Street 1:100 FOSTER ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-2595
Practice Address - Country:US
Practice Address - Phone:508-764-4085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical