Provider Demographics
NPI:1831308956
Name:FEENEY-KETTLER, KELLY ANN (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:FEENEY-KETTLER
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1217
Mailing Address - Country:US
Mailing Address - Phone:615-772-6830
Mailing Address - Fax:
Practice Address - Street 1:31 DEHART ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8619
Practice Address - Country:US
Practice Address - Phone:615-772-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ6611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health