Provider Demographics
NPI:1689268625
Name:MICELI, KYLE NICHOLAS (MSW, LCSW, CSSW,)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:NICHOLAS
Last Name:MICELI
Suffix:
Gender:M
Credentials:MSW, LCSW, CSSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-9724
Mailing Address - Country:US
Mailing Address - Phone:856-235-7126
Mailing Address - Fax:
Practice Address - Street 1:3110 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9724
Practice Address - Country:US
Practice Address - Phone:856-235-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC164851041C0700X
NJ44SC059689001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical