| Organization Name: | KELLY CANZONE, LCSW, LLC |
| NPI Number: | 1124117007 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY CLARE CANZONE (OWNER) |
| Mailing Address: | 129 - 131 Rt. 183 North 2nd Floor, Suite 2 Stanhope |
| State: | NJ US |
| Postal Code: | 07874 |
| Phone Number: | 9738862222 |
| Fax Number: | |
| NPI Enumeration Date: | 10/11/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 44SC05283700 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |