Provider Demographics
NPI:1952038796
Name:KELLY, ANDREA MANNING (LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MANNING
Last Name:KELLY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LORING PL
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-6810
Mailing Address - Country:US
Mailing Address - Phone:617-347-4199
Mailing Address - Fax:
Practice Address - Street 1:1 LORING PL
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-6810
Practice Address - Country:US
Practice Address - Phone:617-347-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty