Provider Demographics
NPI:1285116749
Name:KELLY, JULIA F
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:F
Last Name:KELLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FOREST AVE APT 15E
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-4377
Mailing Address - Country:US
Mailing Address - Phone:908-419-4021
Mailing Address - Fax:
Practice Address - Street 1:2130 MILLBURN AVE STE D1
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3749
Practice Address - Country:US
Practice Address - Phone:973-763-8123
Practice Address - Fax:973-763-8243
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty