Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 3750 | MA |
N | 103T00000X | Psychologist | 3750 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 3750 | MA |
N | 103G00000X | Clinical Psychologist | 3750 | MA |
N | 103TC0700X | Clinical Psychologist | 3750 | MA |
N | 103TF0200X | Forensic Psychologist | 3750 | MA |
N | 103TH0100X | Health Service | 3750 | MA |
NPI | 1033266671 |
---|---|
Provider Name | Dr. Frederick William Kelso |
First Address | Dedham, MA 02027-0003 |
Second Address | Canton, MA 02021-3189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 08/07/2007 |