Healthcare Provider Details

I. General information

NPI: 1831653666
Provider Name (Legal Business Name): KELLY S HUTTON LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 01/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FOSTER ST
SOUTHBRIDGE MA
01550-2595
US

IV. Provider business mailing address

1 GROVE HEIGHTS RD
HOLLAND MA
01521-2611
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-4085
  • Fax:
Mailing address:
  • Phone: 631-220-4432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: