Organization
KENNEDY HEALTH SYSTEM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSS MICOLI MA, MHA (CORP. DIRECTOR, BEHAVIORAL HEALTH)
(856) 488-6701
Entity
Organization
Contact information
Practice address
454 HURFFVILLE CROSSKEYS RD, SEWELL, NJ 08080-2339
(856) 582-1419
(856) 582-7661
Mailing address
2201 CHAPEL AVE W, CHERRY HILL, NJ 08002-2048
(856) 488-6500
(856) 488-6415
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2010
Last updated
05/21/2010
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