Provider Demographics
NPI:1366586398
Name:KELLEY, LOUISE (MSW)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LUISE
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:419 NETHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-4041
Mailing Address - Country:US
Mailing Address - Phone:723-885-0047
Mailing Address - Fax:
Practice Address - Street 1:419 NETHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-4041
Practice Address - Country:US
Practice Address - Phone:723-885-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYR047287-11041C0700X
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical