Healthcare Provider Details

I. General information

NPI: 1912761883
Provider Name (Legal Business Name): KELLY JEAN CAMPBELL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 FORT DE FRANCE
TOMS RIVER NJ
08757
US

IV. Provider business mailing address

52 FORT DE FRANCE AVE
TOMS RIVER NJ
08757-4409
US

V. Phone/Fax

Practice location:
  • Phone: 973-229-4512
  • Fax:
Mailing address:
  • Phone: 973-229-4512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91085
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: