MEDICARE: KATHRYN KELLY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1316268766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN KELLY

Provider Business Mailing Address
First Line	:	125 N ELM ST
Second Line	:
City	:	WESTFIELD
State	:	MA
Zip	:	01085-1643
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 KILBURN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7321
Country	:	US
Telephone Number	:	508-979-1122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/10/2014

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