Healthcare Provider Details

I. General information

NPI: 1306784475
Provider Name (Legal Business Name): DANIELLE JOY KELLIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CB1110, HOUSESTAFF LOUNGE 300 LONGWOOD AVE
BOSTON MA
02115
US

IV. Provider business mailing address

CB1110, HOUSESTAFF LOUNGE 300 LONGWOOD AVE
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6000
  • Fax:
Mailing address:
  • Phone: 617-355-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: