Healthcare Provider Details

I. General information

NPI: 1861065633
Provider Name (Legal Business Name): KATELYN KELLY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E NEWTON ST STE 802
BOSTON MA
02118-3553
US

IV. Provider business mailing address

85 E NEWTON ST STE 802
BOSTON MA
02118-3553
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8013
  • Fax:
Mailing address:
  • Phone: 617-638-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140100
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: