Provider Demographics
NPI:1679718688
Name:KELLY, KATHLEEN NANCY (MSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:NANCY
Last Name:KELLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:NANCY
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:384 COUNTY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-4980
Mailing Address - Country:US
Mailing Address - Phone:888-774-4635
Mailing Address - Fax:
Practice Address - Street 1:384 COUNTY ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-4980
Practice Address - Country:US
Practice Address - Phone:888-774-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10310921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical