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NPI Code Detail

MEDICARE: KELLY TYRRELL

MEDICARE: KELLY TYRRELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker44SC04828200NJ

General Provider Information

NPI Number : 1619380219
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TYRRELL
Provider Business Mailing Address
First Line : 170 DIAMOND SPRING RD
Second Line :
City : DENVILLE
State : NJ
Zip : 07834-2910
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 221 RIVER ST STE 9
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-5990
Country : US
Telephone Number : 973-245-9041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2014
Last Update Date : 05/09/2026

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Directions to “ KELLY TYRRELL ” Practice Location

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