Laurence Merrill Kelly Jr., M.ED., PSY.D.

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

9422 Issued in MA

Practice address

11 Union St
Lawrence, MA 01840-1815

Phone

(978) 685-1337

NPI assigned

Jan 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• North Shore Counseling Center Inc

  • Mental Health Counselor
  • Beverly, MA
  • NPI 1194697482
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317168000000",
    "number": "1750436457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81 GREEN ST",
            "address_2": "APT. 2",
            "city": "READING",
            "state": "MA",
            "postal_code": "018673210",
            "telephone_number": "603-714-4771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 UNION ST",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018401815",
            "telephone_number": "978-685-1337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "LAURENCE",
        "middle_name": "MERRILL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.ED., PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2011-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NH",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MA",
            "license": "9422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zandra S.W. Kelley, M.D.
• Victoria Kellman
• Tamara C. Kellogg, M.D.
• Brittany Kelly, CPNP-PC
• Hannah Jon Kelly, LPN
• Erica Joy Kennedy-Cruz
• Erin Elizabeth Kennedy, OTR/L
• Kenneth Macoul MD Inc
• Sarah Kenney
• Edward J Keohan, LICSW

• Clinical Child & Adolescent Psychologist in Lawrence, MA
• Providers in Lawrence, MA by specialty
• Clinical Child & Adolescent Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.