Provider Demographics
NPI:1669368437
Name:KELLY, AVERY HOPE (MFT-A)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:HOPE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 ROXBURY RD APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3239
Mailing Address - Country:US
Mailing Address - Phone:631-312-2628
Mailing Address - Fax:
Practice Address - Street 1:969 W MAIN ST STE 2A
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2666
Practice Address - Country:US
Practice Address - Phone:203-754-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist