Individual
MR. KELLY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
245 W PROSPECT AVE, KEYPORT, NJ 07735-5030
(732) 358-3080
Mailing address
245 W PROSPECT AVE, KEYPORT, NJ 07735-5030
(732) 358-3080
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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