Individual
BRIAN KELLY
Active
Individual
BRIAN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1029609
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
699909
TUFTS
MA
01
—
P07461
BCBS
MA
Enumeration date
11/29/2006
Last updated
04/08/2025
Update your record
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