Healthcare Provider Details

I. General information

NPI: 1245477470
Provider Name (Legal Business Name): KELLY ELIZABETH WHYTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2009
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 CONGRESS ST STE 1205
SALEM MA
01970-7309
US

IV. Provider business mailing address

102 WESTMOOR RD
BOSTON MA
02132-4741
US

V. Phone/Fax

Practice location:
  • Phone: 617-279-3953
  • Fax:
Mailing address:
  • Phone: 617-441-1743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7957
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: