Individual
SUSAN DALE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LCADC, LCSW
Contact information
Practice address
524 BRIGHTON AVE, SPRING LAKE, NJ 07762-1561
(732) 684-8763
Mailing address
P.O. BOX 1826, BRICK, NJ 08723
(732) 684-8763
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
054613-1
NY
104100000X
Social Worker
Primary
44SL05855300
NJ
Other
Enumeration date
10/31/2015
Last updated
11/30/2018
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