Individual
MR. CHARLES L KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
40 INDUSTRIAL PARK RD, DEPARTMENT OF MENTAL HEALTH, PLYMOUTH, MA 02360-4884
(508) 732-3011
Mailing address
PO BOX 396, BRANT ROCK, MA 02020-0396
(781) 837-9312
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
103859
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PO3270
BLUE SHEILD PROVIDER NUMB
MA
Enumeration date
12/04/2006
Last updated
07/08/2007
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