Provider Demographics
NPI:1922398932
Name:BURNS, KELLY (PHD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 203
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-9344
Mailing Address - Country:US
Mailing Address - Phone:856-582-0033
Mailing Address - Fax:856-582-2305
Practice Address - Street 1:405 HURFFVILLE CROSSKEYS RD STE 203
Practice Address - Street 2:
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-9344
Practice Address - Country:US
Practice Address - Phone:856-582-0033
Practice Address - Fax:856-582-2305
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00593100103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent