Provider Demographics
NPI:1366727398
Name:SHELLEY, KRISTEN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:DARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-0433
Mailing Address - Country:US
Mailing Address - Phone:856-451-4700
Mailing Address - Fax:856-794-2734
Practice Address - Street 1:1200 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2540
Practice Address - Country:US
Practice Address - Phone:856-451-4700
Practice Address - Fax:856-794-7183
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053895001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical