Provider Demographics
NPI:1669580395
Name:GILRAIN, KELLY LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:LYNN
Last Name:GILRAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2328
Mailing Address - Fax:856-541-6137
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 307
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:856-541-6137
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016078103TC0700X
NJPS016078103TC0700X
NJSI00445800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical