Provider Demographics
NPI:1841397536
Name:KELLY, LINDA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:J
Last Name:KELLY
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:336 S PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-5334
Mailing Address - Country:US
Mailing Address - Phone:201-251-1871
Mailing Address - Fax:201-251-3698
Practice Address - Street 1:10 WILSEY SQ
Practice Address - Street 2:SUITE 274
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3792
Practice Address - Country:US
Practice Address - Phone:201-859-2952
Practice Address - Fax:201-251-3698
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ3463103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJKE805395Medicare PIN