Provider Demographics
NPI:1497093397
Name:HOWARD, KELLY AILEEN
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:AILEEN
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:AILEEN
Other - Last Name:MCNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4401
Mailing Address - Country:US
Mailing Address - Phone:856-358-4111
Mailing Address - Fax:
Practice Address - Street 1:9 HARDING HWY
Practice Address - Street 2:
Practice Address - City:PITTSGROVE
Practice Address - State:NJ
Practice Address - Zip Code:08318-4401
Practice Address - Country:US
Practice Address - Phone:856-358-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst