Provider Demographics
NPI:1114045317
Name:KISPERT, ERIC (LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KISPERT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MYERS AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2161
Mailing Address - Country:US
Mailing Address - Phone:973-625-3025
Mailing Address - Fax:973-625-3027
Practice Address - Street 1:40 1ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2710
Practice Address - Country:US
Practice Address - Phone:973-625-3025
Practice Address - Fax:973-625-3027
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046487001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical