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  5. Ms. Kelly G. Ezickson LICSW
Female

Ms. Kelly G. Ezickson LICSW

Social Worker in Quincy, MA(View on Map)

Full Name

Ms. Kelly Gray Ezickson LICSW

NPI Number

1043284839

NPI Type

Individual Provider

Gender

Female

Enumeration Date

02/16/2006

Specialties

(Taxonomies)

Name

Social Worker

Code

104100000X

Primary Taxonomy

Yes

Licenses

State

Massachusetts

License Number

1020756

Contact
Information

Purpose

Mailing
Location

Address

29 COTTAGE AVE SUITE 11
29 COTTAGE AVE SUITE 11

City

Quincy
Quincy

State

MA
MA

Postal Code

02169
02169

Country

US
US

Telephone Number

(617) 472-9838
(617) 472-9838

Identifiers

Identifier

RA P30158
P06289

Identifier State

MA
MA

Identifier Issuer

Unknown
BCBS

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 07/09/2007

Provider Address

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