Individual
KELLY R WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
875 MASSACHUSETTS AVE, SUITE 71, CAMBRIDGE, MA 02139-3067
(857) 600-0875
Mailing address
60 HIGHLAND AVE, APARTMENT 1, CAMBRIDGE, MA 02139-1040
(650) 906-6177
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
9580
MA
Other
Enumeration date
08/21/2010
Last updated
01/15/2013
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