Provider Demographics
NPI:1326593880
Name:PRINTON, KELLY ROSE (LCSW, LCADC)
Entity Type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ROSE
Last Name:PRINTON
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 2ND AVE REAR 2ND
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1165
Mailing Address - Country:US
Mailing Address - Phone:732-688-4018
Mailing Address - Fax:732-851-1031
Practice Address - Street 1:104 BAYARD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2389
Practice Address - Country:US
Practice Address - Phone:732-847-2869
Practice Address - Fax:732-851-1031
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00299800101YA0400X
NJ44SL06092600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)