Provider Demographics
NPI:1104490432
Name:KELLEY, ANN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LOWER WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2890
Mailing Address - Country:US
Mailing Address - Phone:413-322-4929
Mailing Address - Fax:413-322-4992
Practice Address - Street 1:150 LOWER WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2890
Practice Address - Country:US
Practice Address - Phone:413-322-4929
Practice Address - Fax:413-322-4992
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2232701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical