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General NPI Number Information
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NPI Number | 1447636352
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Entity Type | Organization
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Legal Business Name | ANCORA PSYCHOLOGICAL, PLLC
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 591 NORTH AVE DOOR #3, FIRST FLOOR
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City | WAKEFIELD
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State | MA
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Zip | 01880-1647
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Country | US
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Telephone | 781-224-4202
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Fax | 781-224-4203
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Provider Business Mailing Address
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Address Line | 591 NORTH AVE DOOR #3, FIRST FLOOR
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City | WAKEFIELD
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State | MA
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Zip | 01880-1647
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Country | US
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Telephone | 781-224-4202
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Fax | 781-224-4203
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. LAURENCE MERRILL KELLY JR.
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Credential | PSY.D.
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Telephone | 781-224-4202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9422
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License Number State | MA
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