Provider Demographics
NPI:1659863926
Name:MACLEARIE, KELLIE M (LPC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:M
Last Name:MACLEARIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:M
Other - Last Name:SMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 AMY DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2401
Mailing Address - Country:US
Mailing Address - Phone:732-768-2106
Mailing Address - Fax:
Practice Address - Street 1:1 AMY DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2401
Practice Address - Country:US
Practice Address - Phone:732-768-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-03
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00661900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional