Individual
DR. SEAN F. KELLY
Active
Individual
DR. SEAN F. KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1698
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0504513
—
MA
01
—
W01759
BLUE SHIELD PROVIDER ID
MA
01
—
W0175925793
TRICARE
MA
Enumeration date
01/23/2007
Last updated
05/27/2016
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