Individual
KATHERINE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
151 MYSTIC AVE, SUITE SIX, MEDFORD, MA 02155-4632
(781) 396-1199
(781) 396-1439
Mailing address
151 MYSTIC AVE, SUITE SIX, MEDFORD, MA 02155-4632
(781) 396-1199
(781) 396-1439
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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