Kelly E. Venezia Crilly, LAC, NCC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

37AC00614600 Issued in NJ

Practice address

860 Wyckoff Ave Ste 206&305
Mahwah, NJ 07430-3186

Phone

(551) 319-2029

NPI assigned

Dec 30, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kelly Venezia Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Human First Counseling Services

  • Professional Counselor
  • Andover, NJ
  • NPI 1497479810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640822400000",
    "number": "1306506472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 HIBERNIA RD",
            "city": "ROCKAWAY",
            "state": "NJ",
            "postal_code": "078661824",
            "telephone_number": "862-377-4172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 WYCKOFF AVE STE 206&305",
            "city": "MAHWAH",
            "state": "NJ",
            "postal_code": "074303186",
            "telephone_number": "551-319-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENEZIA CRILLY",
        "first_name": "KELLY",
        "middle_name": "E.",
        "credential": "LAC, NCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-30",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YS0200X",
            "taxonomy_group": "",
            "desc": "Counselor, School",
            "state": "NJ",
            "license": "1086514",
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NJ",
            "license": "37AC00614600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "therapynotes.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "860 Wyckoff Ave Ste 206&305",
            "city": "Mahwah",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "074303186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "VENEZIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Counselor in Mahwah, NJ
• Providers in Mahwah, NJ by specialty
• Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.