Provider Demographics
NPI:1285066084
Name:KELLY, CATHERINE ANNE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 SEA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-9229
Mailing Address - Country:US
Mailing Address - Phone:401-533-3862
Mailing Address - Fax:
Practice Address - Street 1:102 SEA VIEW DR
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02889-9229
Practice Address - Country:US
Practice Address - Phone:401-533-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health