Provider Demographics
NPI:1427513555
Name:KELLY, RIANA CARYN (LPC)
Entity type:Individual
Prefix:
First Name:RIANA
Middle Name:CARYN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 COUNTRY FARMS RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1457
Mailing Address - Country:US
Mailing Address - Phone:856-357-0655
Mailing Address - Fax:
Practice Address - Street 1:1000 WHITE HORSE RD STE 804
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4414
Practice Address - Country:US
Practice Address - Phone:856-866-6331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00920300101YM0800X
NJ37AC00451600101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor