Provider Demographics
NPI:1104593987
Name:CORMIER, KELLY ELIZABETH
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ELIZABETH
Last Name:CORMIER
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 1:672 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-1941
Mailing Address - Country:US
Mailing Address - Phone:978-855-5887
Mailing Address - Fax:
Practice Address - Street 1:672 FOSTER RD
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MA
Practice Address - Zip Code:01431-1941
Practice Address - Country:US
Practice Address - Phone:978-855-5887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health