Organization Name: | KELLY REDKOLES, LCSW, LLC |
NPI Number: | 1861822306 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KELLY REDKOLES (THERAPIST/MANAGER/PRESIDENT) |
Mailing Address: | 68 Paulsboro Rd Swedesboro |
State: | NJ US |
Postal Code: | 080851364 |
Phone Number: | 8568895902 |
Fax Number: | 8568895902 |
NPI Enumeration Date: | 11/20/2013 |
NPI Last Update Date: | 11/20/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 44SC05386600 |
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 |