Healthcare Provider Details

I. General information

NPI: 1639805047
Provider Name (Legal Business Name): KELLY A GILSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 LAWRENCE ST
METHUEN MA
01844-4445
US

IV. Provider business mailing address

800 CUMMINGS CTR STE 266T
BEVERLY MA
01915-6172
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-0977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1141688
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: