Provider Demographics
NPI:1184336885
Name:KELLY, ALAINA MARIE (LSW)
Entity type:Individual
Prefix:MRS
First Name:ALAINA
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 WINCHIP RD
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-4142
Mailing Address - Country:US
Mailing Address - Phone:917-626-4810
Mailing Address - Fax:
Practice Address - Street 1:256 COLUMBIA TPKE STE 105
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1229
Practice Address - Country:US
Practice Address - Phone:973-637-1706
Practice Address - Fax:973-765-0195
Is Sole Proprietor?:No
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL068486001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical