Provider Demographics
NPI:1316992977
Name:CANZONE, KELLY CLARE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:CLARE
Last Name:CANZONE
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:BYRAM TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07821-3534
Mailing Address - Country:US
Mailing Address - Phone:201-400-7702
Mailing Address - Fax:
Practice Address - Street 1:4 MAYFAIR LN
Practice Address - Street 2:
Practice Address - City:BYRAM TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07821-3534
Practice Address - Country:US
Practice Address - Phone:201-400-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052837001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical