Provider Demographics
NPI:1245994698
Name:SMITH-PAMPIN, KELLY A (LSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SMITH-PAMPIN
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 1:12 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2541
Mailing Address - Country:US
Mailing Address - Phone:201-819-2367
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN RD STE 2
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9777
Practice Address - Country:US
Practice Address - Phone:973-794-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06529400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker