Healthcare Provider Details

I. General information

NPI: 1003602665
Provider Name (Legal Business Name): ALINA CHEYNE KELLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VANDENBERG DR BLDG 1900
HANSCOM AFB MA
01731-2104
US

IV. Provider business mailing address

10 KELLY LN
HANSCOM AFB MA
01731-2659
US

V. Phone/Fax

Practice location:
  • Phone: 781-225-6789
  • Fax:
Mailing address:
  • Phone: 781-225-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7299-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: