Provider Demographics
NPI:1609895457
Name:KELLY, CYNTHIA CARR (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CARR
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PEACH RD
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7028
Mailing Address - Country:US
Mailing Address - Phone:856-768-0357
Mailing Address - Fax:
Practice Address - Street 1:12000 LINCOLN DR W
Practice Address - Street 2:BLDG. 4, SUITE 407
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3402
Practice Address - Country:US
Practice Address - Phone:856-810-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00080100101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor