Provider Demographics
NPI:1104715754
Name:WIMMER, KRISTEN ALICE (LSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALICE
Last Name:WIMMER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 REMSEN AVE UNIT 529
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-2423
Mailing Address - Country:US
Mailing Address - Phone:732-491-5661
Mailing Address - Fax:
Practice Address - Street 1:3 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-8552
Practice Address - Country:US
Practice Address - Phone:848-932-1181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07143900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker