Individual
TARA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
591 LAKEHURST RD, TOMS RIVER, NJ 08755-8045
(732) 367-1710
Mailing address
PO BOX 476, LITTLE SILVER, NJ 07739-0476
(732) 814-5448
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06567600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029807
—
NJ
Enumeration date
07/07/2020
Last updated
07/07/2020
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