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General NPI Number Information
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NPI Number | 1669241386
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Entity Type | Individual
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Provider Name | KELLY ANN ESPINO LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/21/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 1130 RARITAN RD
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City | CRANFORD
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State | NJ
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Zip | 07016-3378
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Country | US
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Telephone | 856-291-9851
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Fax | 856-741-1611
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Provider Business Mailing Address
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Address Line | 125 PASSAIC AVE APT 309
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City | KEARNY
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State | NJ
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Zip | 07032-1142
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Country | US
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Telephone | 201-983-8129
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL06050400
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License Number State | NJ
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