Provider Demographics
NPI:1033448972
Name:KELLY, MARIA VIRGINIA (L AC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VIRGINIA
Last Name:KELLY
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 JEFFERSON TRL
Mailing Address - Street 2:
Mailing Address - City:HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07843-1517
Mailing Address - Country:US
Mailing Address - Phone:718-207-0438
Mailing Address - Fax:
Practice Address - Street 1:142 JEFFERSON TRL # IG
Practice Address - Street 2:
Practice Address - City:HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07843-1517
Practice Address - Country:US
Practice Address - Phone:718-207-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ101Y00000X
NY004131-1171100000X
NJ25MZ00070300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor