MEDICARE: MS. KATHLEEN ANN KIELY MSW, LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1029211	MA

General Provider Information

NPI Number	:	1073694428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANN KIELY MSW, LICSW

Provider Business Mailing Address
First Line	:	15 RUFUS JONES LN
Second Line	:
City	:	NORTH EASTON
State	:	MA
Zip	:	02356-1729
Country	:	US
Telephone Number	:	617-875-9976
Fax Number	:	508-790-0899

Provider Business Practice Location Address
First Line	:	270 COMMUNICATION WAY
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-1883
Country	:	US
Telephone Number	:	508-778-4627
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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