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Individual
MRS. VICKI LEIGH KELLAM
Active
Individual
MRS. VICKI LEIGH KELLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
115264
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042611055
TAX ID
—
01
—
1004745
NHP
MA
01
—
1303287
MBHP
MA
05
—
1303287
—
MA
01
—
703136
TUFTS
—
01
—
996
NETWORK HEALTH
—
01
—
M18633
BCBS
—
01
—
NP01332
BOSTON MED
—
Enumeration date
10/23/2006
Last updated
07/22/2025
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