Organization
EXTRACARE HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN J KELLY CSW, CDC (EXECUTIVE DIRECTOR)
(732) 721-0060
Entity
Organization
Contact information
Practice address
141 STATE ROUTE 34, MATAWAN, NJ 07747-2187
(732) 721-3835
(239) 455-9027
Mailing address
141 STATE ROUTE 34, P O BOX 506, MATAWAN, NJ 07747-2187
(732) 721-3835
(239) 455-9027
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
PSYD-2136
NJ
Other
Enumeration date
01/23/2007
Last updated
08/22/2020
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