Provider Demographics
NPI:1871627950
Name:KELLEHER, EMILY JEANNE (MA, LMHC, GCEA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JEANNE
Last Name:KELLEHER
Suffix:
Gender:F
Credentials:MA, LMHC, GCEA
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:JEANNE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 WOLCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-5921
Mailing Address - Country:US
Mailing Address - Phone:401-848-6363
Mailing Address - Fax:401-848-6389
Practice Address - Street 1:26 VALLEY RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-6371
Practice Address - Country:US
Practice Address - Phone:401-848-6363
Practice Address - Fax:401-848-6389
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIEA64005Medicaid