Provider Demographics
NPI:1396150728
Name:CIARDIELLO, KELLY J (LPC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:CIARDIELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-1326
Mailing Address - Country:US
Mailing Address - Phone:908-386-3100
Mailing Address - Fax:
Practice Address - Street 1:17 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1326
Practice Address - Country:US
Practice Address - Phone:908-386-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health