Provider Demographics
NPI:1144564121
Name:REYNOLDS, KELLY ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1216
Mailing Address - Country:US
Mailing Address - Phone:617-458-3098
Mailing Address - Fax:
Practice Address - Street 1:7 NOWELL RD
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-1216
Practice Address - Country:US
Practice Address - Phone:617-458-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical