Healthcare Provider Details

I. General information

NPI: 1104309699
Provider Name (Legal Business Name): KANDICE COVELLI LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 COURT ST
FREEHOLD NJ
07728-1700
US

IV. Provider business mailing address

200 MIDDLESEX RD APT 210
MATAWAN NJ
07747-3032
US

V. Phone/Fax

Practice location:
  • Phone: 732-780-7387
  • Fax:
Mailing address:
  • Phone: 732-239-2841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05684700
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: