Healthcare Provider Details

I. General information

NPI: 1306023338
Provider Name (Legal Business Name): KELLY MARCHIONE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD UNIVERSITY DOCTORS PAVILLON, SUITE 1100
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD UNIVERSITY DOCTORS PAVILLON, SUITE 1100
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7036
  • Fax:
Mailing address:
  • Phone: 856-566-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05615200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: