Provider Demographics
NPI:1447940341
Name:ALVES, KELLY ANDRADE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANDRADE
Last Name:ALVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LOUIS ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1814
Mailing Address - Country:US
Mailing Address - Phone:774-257-3998
Mailing Address - Fax:
Practice Address - Street 1:16 LOUIS ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1814
Practice Address - Country:US
Practice Address - Phone:774-257-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician