Provider Demographics
NPI:1013949007
Name:HARGADON, KELLY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:HARGADON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:BROWN
Other - Last Name:HARGADON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1600 NEW RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1108
Mailing Address - Country:US
Mailing Address - Phone:609-601-2479
Mailing Address - Fax:609-601-2478
Practice Address - Street 1:1600 NEW RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1108
Practice Address - Country:US
Practice Address - Phone:609-601-2479
Practice Address - Fax:609-601-2478
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00429600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist