Provider Demographics
NPI:1871140004
Name:KELLEY, AMY J
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:KELLEY
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 1:28 PRINCESS PINE LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1350
Mailing Address - Country:US
Mailing Address - Phone:508-328-8524
Mailing Address - Fax:
Practice Address - Street 1:28 PRINCESS PINE LN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1350
Practice Address - Country:US
Practice Address - Phone:508-328-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst