Clark, Kelly

Clark, Kelly is an individual health care provider with primary practice located at 171 Main St Ste 401, Milford MA 01757. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Clark, Kelly can be contacted via phone (508) 473-4984.

Contact Information

Primary practice address
171 Main St Ste 401 Milford MA 01757
Phone: (508) 473-4984
Fax: (508) 482-7316
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 1074

Profile Details

NPI number 1598856759
LBN Legal business name Clark, Kelly
Credentials MA CAGS
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 27th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598856759 NPPES
Massachusetts Other LM0158 BCBS

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