Individual
MR. ETHAN A. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
263 MAIN ST, OLD SAYBROOK, CT 06475-2326
(860) 395-6380
(860) 395-6382
Mailing address
263 MAIN ST, OLD SAYBROOK, CT 06475-2326
(860) 395-6380
(860) 395-6382
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/19/2011
Last updated
04/26/2011
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