Provider Demographics
NPI:1528350824
Name:KELLY, LAVERNE M
Entity type:Individual
Prefix:MS
First Name:LAVERNE
Middle Name:M
Last Name:KELLY
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:PO BOX 3651
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-3651
Mailing Address - Country:US
Mailing Address - Phone:413-307-0333
Mailing Address - Fax:413-541-0055
Practice Address - Street 1:409 MAIN ST
Practice Address - Street 2:STE 125
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2346
Practice Address - Country:US
Practice Address - Phone:413-307-0333
Practice Address - Fax:413-541-0055
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical