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NPI Code Detail

MEDICARE: KELLY WRIGHT MS

MEDICARE: KELLY WRIGHT MS
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
1101YM0800XMental Health CounselorP106850NY

General Provider Information

NPI Number : 1457944902
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY WRIGHT MS
Provider Business Mailing Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Provider Business Practice Location Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2021
Last Update Date : 02/16/2021

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