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General NPI Number Information
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NPI Number | 1417401951
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Entity Type | Individual
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Provider Name | DR. KELSEY MORAN
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Gender | Female
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Dates
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Enumeration Date | 08/13/2016
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 1 COLLEGE STREET BOX D
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City | WORCESTER
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State | MA
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Zip | 01610
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Country | US
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Telephone | 508-793-3363
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Fax |
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Provider Business Mailing Address
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Address Line | 1 COLLEGE STREET BOX D
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City | WORCESTER
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State | MA
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Zip | 01610
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Country | US
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Telephone | 508-793-3363
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 10917
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1745
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License Number State | RI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11059
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License Number State | MA
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