Healthcare Provider Details

I. General information

NPI: 1508702176
Provider Name (Legal Business Name): GRACE ANN KELLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N MAIN ST BLDG 26
LEEDS MA
01053-9796
US

IV. Provider business mailing address

425 N MAIN ST BLDG 26
LEEDS MA
01053-9796
US

V. Phone/Fax

Practice location:
  • Phone: 413-822-1183
  • Fax:
Mailing address:
  • Phone: 413-822-1183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2141848
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: