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General NPI Number Information
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NPI Number | 1598801920
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Entity Type | Individual
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Provider Name | JOELLE ANN KELLY PHD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23 BAY STATE COURT
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City | BREWSTER
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State | MA
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Zip | 02631-2120
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Country | US
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Telephone | 508-430-0589
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Fax | 508-430-5207
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Provider Business Mailing Address
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Address Line | 23 BAY STATE COURT
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City | BREWSTER
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State | MA
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Zip | 02631-2120
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Country | US
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Telephone | 508-430-0589
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Fax | 508-430-5207
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY4274
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS0595
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License Number State | ME
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