Healthcare Provider Details

I. General information

NPI: 1124870167
Provider Name (Legal Business Name): KELLY A. BRADFORD - PARRELLA SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY A BRADFORD SOCIAL WORKER

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HILLTOP RD
KINNELON NJ
07405-2123
US

IV. Provider business mailing address

14 HILLTOP RD
KINNELON NJ
07405-2123
US

V. Phone/Fax

Practice location:
  • Phone: 646-831-8408
  • Fax:
Mailing address:
  • Phone: 646-831-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number44SL05376300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number1037062
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: