Provider Demographics
NPI:1922398932
Name:BURNS, KELLY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 ROUTE 322 UNIT C
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-3701
Mailing Address - Country:US
Mailing Address - Phone:856-975-6279
Mailing Address - Fax:856-975-6281
Practice Address - Street 1:1630 ROUTE 322 UNIT C
Practice Address - Street 2:
Practice Address - City:WOOLWICH TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-3701
Practice Address - Country:US
Practice Address - Phone:856-975-6279
Practice Address - Fax:856-975-6281
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00593100103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent