Provider Demographics
NPI:1295876332
Name:WARD, KELLY S (PHD, LCSW, LCADC)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:S
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD, LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 871
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748
Mailing Address - Country:US
Mailing Address - Phone:732-778-3873
Mailing Address - Fax:732-272-0706
Practice Address - Street 1:24 MOSSY ROCK LANE
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748
Practice Address - Country:US
Practice Address - Phone:732-328-9273
Practice Address - Fax:732-272-0706
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2008R101YA0400X
NJLCSW44SCO45160001041C0700X
NJSC451601041C0700X
NJLCADC37LC000854001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)