Provider Demographics
NPI:1528396140
Name:DAUBER, KELLY LYN (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYN
Last Name:DAUBER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COLEMAN LN
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08560-1610
Mailing Address - Country:US
Mailing Address - Phone:609-933-8506
Mailing Address - Fax:609-933-8506
Practice Address - Street 1:28 COLEMAN LN
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08560-1610
Practice Address - Country:US
Practice Address - Phone:609-933-8506
Practice Address - Fax:609-933-8506
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ37PC00536000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist