Healthcare Provider Details

I. General information

NPI: 1851671069
Provider Name (Legal Business Name): KELLIE MARIE PERKINS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 05/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 VILLAGE INN RD STE F
WESTMINSTER MA
01473-1660
US

IV. Provider business mailing address

23 VILLAGE INN RD STE F
WESTMINSTER MA
01473-1660
US

V. Phone/Fax

Practice location:
  • Phone: 978-549-6059
  • Fax: 978-874-0200
Mailing address:
  • Phone: 978-549-6059
  • Fax: 978-874-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000008900
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: