Provider Demographics
NPI:1992186779
Name:KELLEY, KATHRYN (LMHC, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:
Credentials:LMHC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHILTON AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1746
Mailing Address - Country:US
Mailing Address - Phone:819-742-4787
Mailing Address - Fax:
Practice Address - Street 1:27 CHILTON AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:MA
Practice Address - Zip Code:02364-1746
Practice Address - Country:US
Practice Address - Phone:781-974-2478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
MARN2363193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health