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General NPI Number Information
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NPI Number | 1922403955
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Entity Type | Individual
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Provider Name | KIMBERLY C. KELLY M.ED., BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 04/15/2019
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Provider Practice Location Address
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Address Line | 62 LOWELL ST STE 5
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City | MANCHESTER
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State | NH
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Zip | 03101-1607
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Country | US
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Telephone | 603-664-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CUMMINGS CTR 157J
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City | BEVERLY
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State | MA
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Zip | 01915-6115
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Country | US
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Telephone | 978-969-6019
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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