Provider Demographics
NPI:1104309699
Name:COVELLI, KANDICE (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:
Last Name:COVELLI
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIDDLESEX RD APT 210
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3032
Mailing Address - Country:US
Mailing Address - Phone:732-239-2841
Mailing Address - Fax:
Practice Address - Street 1:22 COURT ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-1700
Practice Address - Country:US
Practice Address - Phone:732-780-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM44SC056847001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical