Healthcare Provider Details

I. General information

NPI: 1508061185
Provider Name (Legal Business Name): NANCY KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W CUMMINGS PARK SUITE 3900
WOBURN MA
01801-6503
US

IV. Provider business mailing address

7 LINCOLN ST STE 304A
WAKEFIELD MA
01880-3021
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-6550
  • Fax:
Mailing address:
  • Phone: 781-780-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC7196
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: