Provider Demographics
NPI:1386966224
Name:YOUNG, KELLIE ANNE (MA, MFT)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ANNE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3644
Mailing Address - Country:US
Mailing Address - Phone:617-364-5573
Mailing Address - Fax:
Practice Address - Street 1:651 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2919
Practice Address - Country:US
Practice Address - Phone:508-620-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMH 1242-MF106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist