Individual
MS. KELLY ELIZABETH CUNNINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS/ADDICTIONS
Contact information
Practice address
23 BRADSTON ST, BOSTON, MA 02118-2703
(617) 318-6484
(617) 427-1263
Mailing address
23 BRADSTON ST, BOSTON, MA 02118-2703
(617) 318-6484
(617) 427-1263
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9999
—
MA
Enumeration date
08/11/2021
Last updated
08/11/2021
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