Provider Demographics
NPI:1457224750
Name:RODRIGUES DOSOUTO, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RODRIGUES DOSOUTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GAYLORD ST
Mailing Address - Street 2:STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-1111
Mailing Address - Country:US
Mailing Address - Phone:617-704-0555
Mailing Address - Fax:
Practice Address - Street 1:7 GAYLORD ST
Practice Address - Street 2:STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-1111
Practice Address - Country:US
Practice Address - Phone:617-704-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty