Individual
BRIAN KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
140 HIGH ST STE 230, SPRINGFIELD, MA 01105-1435
(413) 459-1500
Mailing address
88 REGENCY PARK DR, AGAWAM, MA 01001-2257
(860) 406-5351
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/17/2019
Last updated
01/17/2019
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