Healthcare Provider Details

I. General information

NPI: 1548501067
Provider Name (Legal Business Name): CYNTHIA KELLY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 LACEY RD
FORKED RIVER NJ
08731-1051
US

IV. Provider business mailing address

1044 LACEY RD
FORKED RIVER NJ
08731-1051
US

V. Phone/Fax

Practice location:
  • Phone: 732-228-4547
  • Fax:
Mailing address:
  • Phone: 732-228-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: