Kelly, Justin C

Kelly, Justin C is an individual health care provider with primary practice located at 2020 Centre St , West Roxbury MA 02132-3316. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Counselor is his primary health care specialty. Kelly, Justin C can be contacted via phone (781) 437-1323.

Contact Information

Primary practice address
2020 Centre St West Roxbury MA 02132-3316
Phone: (781) 437-1323
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1447406376
LBN Legal business name Kelly, Justin C
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 12th, 2008
Last updated Aug 12th, 2008 - about 16 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 1447406376 NPPES
Massachusetts Other M18708 BLUE CROSS
Massachusetts MEDICAID 1312685 BLUE CROSS
Massachusetts MEDICAID 1312677 BLUE CROSS
Massachusetts Other 685661 BLUE CROSS

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