Individual
KELLY JOY KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
307 QUEEN ANNE RD, HARWICH, MA 02645-2501
(774) 209-1268
Mailing address
307 QUEEN ANNE RD, HARWICH, MA 02645-2501
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
S69733883
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B00145865
BOSTON MEDICAL CENTER HEALTH NET PLAN
MA
Enumeration date
01/04/2016
Last updated
01/04/2016
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