Ezickson, Kelly Gray
Ezickson, Kelly Gray is an individual health care provider with primary practice located at 29 Cottage Ave Suite 11 , Quincy MA 02169. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Ezickson, Kelly Gray can be contacted via phone (617) 472-9838.Contact Information
Primary practice address
29 Cottage Ave Suite 11
Quincy MA 02169
Phone: (617) 472-9838
Fax: (617) 472-6269
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Social Worker | 104100000X | 1020756 | Massachusetts |
Profile Details
| NPI number | 1043284839 |
|---|---|
| LBN Legal business name | Ezickson, Kelly Gray |
| Credentials | LICSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 16th, 2006 |
| Last updated | Jul 9th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1043284839 | NPPES |
| Massachusetts | MEDICAID | RA P30158 | |
| Massachusetts | Other | P06289 |
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