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NPI Code Detail

MEDICARE: CONNOR KELLETT LCSW

MEDICARE:   CONNOR  KELLETT  LCSW
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
11041C0700XClinical Social Worker226871MA

General Provider Information

NPI Number : 1780364752
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONNOR KELLETT LCSW
Provider Business Mailing Address
First Line : 500 FALLS BLVD APT 5211
Second Line :
City : QUINCY
State : MA
Zip : 02169-8178
Country : US
Telephone Number : 508-808-2969
Fax Number :
Provider Business Practice Location Address
First Line : 673 BEDFORD ST
Second Line :
City : ABINGTON
State : MA
Zip : 02351-1921
Country : US
Telephone Number : 508-808-2969
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2023
Last Update Date : 07/24/2023

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Directions to “ CONNOR KELLETT LCSW” Practice Location

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