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General NPI Number Information
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NPI Number | 1487922407
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Entity Type | Organization
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Legal Business Name | KELLEY GEMMA, LLC
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Dates
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Enumeration Date | 12/05/2011
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Last Update Date | 12/05/2011
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Provider Practice Location Address
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Address Line | 1130 TEN ROD RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-4161
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Country | US
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Telephone | 401-268-3886
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Fax |
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Provider Business Mailing Address
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Address Line | 1130 TEN ROD RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-4161
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Country | US
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Telephone | 401-268-3886
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. KELLEY ELIZABETH GEMMA
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Credential | LICSW
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Telephone | 401-268-3886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW01777
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License Number State | RI
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