Provider Demographics
NPI:1992463905
Name:CLARY, KELLIE (BCBA)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:CLARY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01543-1713
Mailing Address - Country:US
Mailing Address - Phone:508-414-3286
Mailing Address - Fax:
Practice Address - Street 1:1 WHITNEY RD
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MA
Practice Address - Zip Code:01503-1653
Practice Address - Country:US
Practice Address - Phone:855-222-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst