MS. KELLY GRAY EZICKSON LICSW NPI 1043284839

NPI Information

  • NPI: 1043284839
  • Provider Name: MS. KELLY GRAY EZICKSON, LICSW
  • Classification: Social Worker - 104100000X
  • Entity Type: Individual
  • Address: 29 COTTAGE AVE SUITE 11
    QUINCY, MA
    ZIP 02169
  • Phone: (617) 472-9838

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NPI Details

MS. Kelly Gray Ezickson, LICSW is a social worker in Quincy, MA. The provider is a social worker is a person who is qualified by a Social Work degree, and licensed, certified or registered by the state as a social worker to practice within the scope of that license. A social worker provides assistance and counseling to clients and their families who are dealing with social, emotional and environmental problems. Social work services may be rendered to individuals, families, groups, and the public. MS. Kelly Gray Ezickson, LICSW NPI is 1043284839. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

29 COTTAGE AVE SUITE 11
QUINCY, MA
ZIP 02169
Phone: (617) 472-9838
Fax: (617) 472-6269

The enumeration date for this NPI number is 2/16/2006 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1104100000XSocial Worker1020756MASSACHUSETTSYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P06289OTHERMASSACHUSETTSBCBS
2RA P30158MEDICAIDMASSACHUSETTS
3EZ P23326MEDICARE ID-TYPE UNSPECIFIEDMASSACHUSETTSIND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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