Healthcare Provider Details

I. General information

NPI: 1619794120
Provider Name (Legal Business Name): KELLY LYNN PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CATHY LN STE 103
BURLINGTON NJ
08016-9727
US

IV. Provider business mailing address

60 CATHY LN STE 103
BURLINGTON NJ
08016-9727
US

V. Phone/Fax

Practice location:
  • Phone: 609-499-0165
  • Fax: 609-499-0685
Mailing address:
  • Phone: 609-499-0165
  • Fax: 609-499-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00825700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: