Provider Demographics
NPI:1003582867
Name:GARCIA-MORAN, KIERSTEN MCKENZIE
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:MCKENZIE
Last Name:GARCIA-MORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1307
Mailing Address - Country:US
Mailing Address - Phone:484-515-6125
Mailing Address - Fax:609-400-4888
Practice Address - Street 1:6102 HAMILTON WAY
Practice Address - Street 2:
Practice Address - City:EASTAMPTON TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08060-1673
Practice Address - Country:US
Practice Address - Phone:484-515-1625
Practice Address - Fax:609-400-4888
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health