Individual
DR. KELLY RILEY GUNDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
1234 BROADWAY, SOMERVILLE, MA 02144-1703
(617) 855-3986
Mailing address
15 JEFFERSON ST, NEWTON, MA 02458-1709
(617) 558-3681
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
8523
MA
Other
Enumeration date
02/15/2007
Last updated
07/08/2007
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