Provider Demographics
NPI:1124870167
Name:BRADFORD - PARRELLA, KELLY A (SOCIAL WORKER)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:A
Last Name:BRADFORD - PARRELLA
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:14 HILLTOP RD
Mailing Address - Street 2:
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2123
Mailing Address - Country:US
Mailing Address - Phone:646-831-8408
Mailing Address - Fax:
Practice Address - Street 1:14 HILLTOP RD
Practice Address - Street 2:
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2123
Practice Address - Country:US
Practice Address - Phone:646-831-8408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1037062101YS0200X
NJ44SL05376300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool