Provider Demographics
NPI:1063138212
Name:CREIGHTON, KELLIANNE
Entity type:Individual
Prefix:
First Name:KELLIANNE
Middle Name:
Last Name:CREIGHTON
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 1:301 POPLAR ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-3665
Mailing Address - Country:US
Mailing Address - Phone:978-804-2763
Mailing Address - Fax:
Practice Address - Street 1:20 CABOT BLVD STE 227
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1183
Practice Address - Country:US
Practice Address - Phone:508-589-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor