MEDICARE: DR. VIRGINIA A. KELTY PH. D.

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	103TC0700X	Clinical Psychologist	4185	MA

General Provider Information

NPI Number	:	1083768790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIRGINIA A. KELTY PH. D.

Provider Business Mailing Address
First Line	:	8 WASHINGTON PL
Second Line	:	SUITE 104
City	:	BRAINTREE
State	:	MA
Zip	:	02184-3259
Country	:	US
Telephone Number	:	781-848-1903
Fax Number	:	781-545-5189

Provider Business Practice Location Address
First Line	:	8 WASHINGTON PL
Second Line	:	SUITE 104
City	:	BRAINTREE
State	:	MA
Zip	:	02184-3259
Country	:	US
Telephone Number	:	781-848-1903
Fax Number	:	781-545-5189

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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