Individual
JENNIFER KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37AC00527400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
913134183
UNITED HEALTHCARE
NJ
Enumeration date
07/14/2020
Last updated
07/14/2020
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