Kelly, Tara
Kelly, Tara is an individual health care provider with primary practice located at 4 Broadway Avenue Ext Ste 3 , Mystic CT 06355-2875. She recently has only one registered license in Behavioral Health & Social Service Providers / Behavior Technician, which is considered as her primary health care specialty. Kelly, Tara can be contacted via phone (860) 980-3233.Contact Information
Primary practice address
4 Broadway Avenue Ext Ste 3
Mystic CT 06355-2875
Phone: (860) 980-3233
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Behavior Technician | 106S00000X | Connecticut |
Profile Details
| NPI number | 1992371504 |
|---|---|
| LBN Legal business name | Kelly, Tara |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 3rd, 2021 |
| Last updated | Jun 3rd, 2021 - about 4 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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