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General NPI Number Information
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NPI Number | 1326593880
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Entity Type | Individual
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Provider Name | KELLY ROSE PRINTON LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 104 BAYARD ST 2ND FLOOR
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City | NEW BRUNSWICK
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State | NJ
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Zip | 08901-2389
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Country | US
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Telephone | 732-847-2869
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Fax | 732-851-1031
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Provider Business Mailing Address
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Address Line | 611 2ND AVE REAR 2ND
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City | BRADLEY BEACH
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State | NJ
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Zip | 07720-1165
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Country | US
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Telephone | 732-688-4018
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Fax | 732-851-1031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00299800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06092600
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License Number State | NJ
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