Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1043557135 |
---|---|
Provider Name | Dr. Kelly Jean Lowery |
First Address | Boston, MA 02114-4407 |
Second Address | Boston, MA 02114-4407 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 09/01/2013 |