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General NPI Number Information
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NPI Number | 1356044820
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Entity Type | Individual
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Provider Name | KELLY DAWN KELLY LSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 41 BROWNSTONE WAY
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1210
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Country | US
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Telephone | 914-539-7090
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Fax |
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Provider Business Mailing Address
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Address Line | 2360 ROUTE 33 STE 112-219
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City | ROBBINSVILLE
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State | NJ
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Zip | 08691-1415
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Country | US
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Telephone | 914-539-7090
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL06876400
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License Number State | NJ
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