Healthcare Provider Details

I. General information

NPI: 1710113394
Provider Name (Legal Business Name): KELLEY ANNE BROWN MA, LPC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WHITEWOOD ST
OLD SAYBROOK CT
06475-4129
US

IV. Provider business mailing address

PO BOX 174
OLD SAYBROOK CT
06475-0174
US

V. Phone/Fax

Practice location:
  • Phone: 720-215-5908
  • Fax:
Mailing address:
  • Phone: 720-215-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8192
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0013144
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005933-3
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7970
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: