Provider Demographics
NPI:1538371588
Name:BLY, BRENDA KILLEEN (LCSW,LCADC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:KILLEEN
Last Name:BLY
Suffix:
Gender:F
Credentials:LCSW,LCADC
Other - Prefix:MISS
Other - First Name:BRENDA
Other - Middle Name:FRANCES
Other - Last Name:KILLEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:387 TERRACE LN
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1927
Mailing Address - Country:US
Mailing Address - Phone:908-719-9669
Mailing Address - Fax:
Practice Address - Street 1:1 MANOR DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08827-5409
Practice Address - Country:US
Practice Address - Phone:908-537-6815
Practice Address - Fax:908-537-6400
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00134400101YA0400X
NJ44SC004371001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical