Individual
STACY KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
17 W RED BANK AVE, WOODBURY, NJ 08096-1630
(718) 215-5311
Mailing address
17 W RED BANK AVE, WOODBURY, NJ 08096-1630
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NJ
Other
Enumeration date
06/25/2026
Last updated
06/25/2026
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