Provider Demographics
NPI:1700939071
Name:KELLY, JANE ANNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANNE
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-3751
Mailing Address - Country:US
Mailing Address - Phone:973-279-3233
Mailing Address - Fax:973-989-7750
Practice Address - Street 1:43 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7508
Practice Address - Country:US
Practice Address - Phone:973-279-3233
Practice Address - Fax:973-989-7750
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2009-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053388001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical