Provider Demographics
NPI:1457772436
Name:BAKER, KELLY M (MS,LPC)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KEYSTONE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1600
Mailing Address - Country:US
Mailing Address - Phone:848-459-8718
Mailing Address - Fax:
Practice Address - Street 1:1 KEYSTONE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1600
Practice Address - Country:US
Practice Address - Phone:856-424-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-18
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00166700101Y00000X
NJ37PC00529200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor