Healthcare Provider Details

I. General information

NPI: 1669241386
Provider Name (Legal Business Name): KELLY ANN ESPINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 RARITAN RD
CRANFORD NJ
07016-3378
US

IV. Provider business mailing address

125 PASSAIC AVE APT 309
KEARNY NJ
07032-1142
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-9851
  • Fax: 856-741-1611
Mailing address:
  • Phone: 201-983-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06050400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: