Provider Demographics
NPI:1164225645
Name:KELLY, SIBHAN (BCBA)
Entity type:Individual
Prefix:
First Name:SIBHAN
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2336
Mailing Address - Country:US
Mailing Address - Phone:856-952-6963
Mailing Address - Fax:
Practice Address - Street 1:2433 CHURCH RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1243
Practice Address - Country:US
Practice Address - Phone:856-952-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst