Healthcare Provider Details

I. General information

NPI: 1083749006
Provider Name (Legal Business Name): KELLY A KOBYLANSKI III M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 MAIN ST
HOLYOKE MA
01040
US

IV. Provider business mailing address

1233 MAIN ST
HOLYOKE MA
01040
US

V. Phone/Fax

Practice location:
  • Phone: 413-539-2480
  • Fax: 413-539-2480
Mailing address:
  • Phone: 413-539-2480
  • Fax: 413-539-2480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: