Provider Demographics
NPI:1942740477
Name:BISSON, KELSEY OAKES (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:OAKES
Last Name:BISSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 GODWIN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1463
Mailing Address - Country:US
Mailing Address - Phone:201-444-8110
Mailing Address - Fax:201-444-8177
Practice Address - Street 1:666 GODWIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1463
Practice Address - Country:US
Practice Address - Phone:201-444-8110
Practice Address - Fax:201-444-8177
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05603300104100000X
NJ44SC057747001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker