Healthcare Provider Details

I. General information

NPI: 1619380219
Provider Name (Legal Business Name): KELLY TYRRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY MCNAMARA LCSW

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RIVER ST STE 9
HOBOKEN NJ
07030-5990
US

IV. Provider business mailing address

170 DIAMOND SPRING RD
DENVILLE NJ
07834-2910
US

V. Phone/Fax

Practice location:
  • Phone: 973-245-9041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04828200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: