Organization
MARNIE KELLY-CROOK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARNIE M KELLY-CROOK LICSW, MSW (PRESIDENT)
(508) 667-3133
Entity
Organization
Contact information
Practice address
54 EVERGREEN RD, NATICK, MA 01760-1636
(508) 667-3133
Mailing address
54 EVERGREEN RD, NATICK, MA 01760-1636
(508) 667-3133
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1031867
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1031867
LICSW - LICENSE#
MA
01
—
1265506976
INDIVIDUAL NPI#
MA
05
—
1851403
—
MA
01
—
P07585
BLUE CROSS / BLUE SHIELD OF MASSACHUSETTS
MA
01
—
P21840
MEDICARE PROVIDER#
MA
Enumeration date
03/06/2009
Last updated
03/06/2009
Update your record
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