Healthcare Provider Details

I. General information

NPI: 1316580103
Provider Name (Legal Business Name): KELLY KLEIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST BLDG 2
BROCKTON MA
02301-5596
US

IV. Provider business mailing address

940 BELMONT ST BLDG 2
BROCKTON MA
02301-5596
US

V. Phone/Fax

Practice location:
  • Phone: 774-824-4884
  • Fax:
Mailing address:
  • Phone: 774-824-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11192
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: