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Individual

DR. JOHN M KELLEY

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PHD

Contact information

Practice address
55 FRUIT ST, WAC 812, BOSTON, MA 02114-2621
(978) 927-5840
(617) 726-7541
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
7787
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
EYW06020
BLUE CROSS BLUE SHIELD
MA
Enumeration date
11/02/2005
Last updated
07/08/2007
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