Provider Demographics
NPI:1447374228
Name:KELLY-LEH, GAY MARIE (MSW)
Entity type:Individual
Prefix:MS
First Name:GAY
Middle Name:MARIE
Last Name:KELLY-LEH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MUNN LN
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3028
Mailing Address - Country:US
Mailing Address - Phone:215-680-2989
Mailing Address - Fax:856-241-0745
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:NJ
Practice Address - Zip Code:08014-9741
Practice Address - Country:US
Practice Address - Phone:856-241-0744
Practice Address - Fax:856-241-0745
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC049938001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical