Provider Demographics
NPI:1366929945
Name:PATEL, KELLY (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LAFAYETTE AVE STE 1-1008
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4177
Mailing Address - Country:US
Mailing Address - Phone:929-470-1186
Mailing Address - Fax:929-205-2611
Practice Address - Street 1:30 LAFAYETTE AVE STE 1-1008
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4177
Practice Address - Country:US
Practice Address - Phone:929-470-1186
Practice Address - Fax:929-205-2611
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2024-11-12
Deactivation Date:2019-06-15
Deactivation Code:
Reactivation Date:2019-07-24
Provider Licenses
StateLicense IDTaxonomies
NY0923471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical