Individual
JUSTIN C KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2020 CENTRE ST, WEST ROXBURY, MA 02132-3316
(781) 437-1323
Mailing address
2020 CENTRE ST, WEST ROXBURY, MA 02132-3316
(781) 437-1323
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1312677
—
MA
05
—
1312685
—
MA
01
—
685661
TUFTS
MA
01
—
M18708
BLUE CROSS
MA
Enumeration date
08/12/2008
Last updated
08/12/2008
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