Provider Demographics
NPI:1336766351
Name:SANTOS-PETERSON, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SANTOS-PETERSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WATER ST STE A210
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4062
Mailing Address - Country:US
Mailing Address - Phone:508-237-0225
Mailing Address - Fax:
Practice Address - Street 1:225 WATER ST STE A210
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4062
Practice Address - Country:US
Practice Address - Phone:781-532-3354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-26
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health