Provider Demographics
NPI:1851671069
Name:PERKINS, KELLIE MARIE (MS)
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:MARIE
Last Name:PERKINS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VILLAGE INN RD STE F
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01473-1660
Mailing Address - Country:US
Mailing Address - Phone:978-549-6059
Mailing Address - Fax:978-874-0200
Practice Address - Street 1:23 VILLAGE INN RD STE F
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01473-1660
Practice Address - Country:US
Practice Address - Phone:978-549-6059
Practice Address - Fax:978-874-0200
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA000008900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health