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NPI Code Detail

MEDICARE: MISS MAEGAN ELIZABETH KELLEY MSW, LADC-1

MEDICARE: MISS MAEGAN ELIZABETH KELLEY MSW, LADC-1
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
1101Y00000XCounselor25307MA

General Provider Information

NPI Number : 1578813721
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MAEGAN ELIZABETH KELLEY MSW, LADC-1
Provider Business Mailing Address
First Line : 81 DUFAULT ST
Second Line :
City : PUTNAM
State : CT
Zip : 06260-1109
Country : US
Telephone Number : 617-872-5139
Fax Number :
Provider Business Practice Location Address
First Line : 107 LINCOLN ST
Second Line :
City : WORCESTER
State : MA
Zip : 01605-2401
Country : US
Telephone Number : 508-453-3013
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2012
Last Update Date : 05/04/2026

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