Provider Demographics
NPI:1114629029
Name:THIELMAN, KRISTINE MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MICHELLE
Last Name:THIELMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 ADAMS ST APT 3
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-2858
Mailing Address - Country:US
Mailing Address - Phone:716-472-6363
Mailing Address - Fax:
Practice Address - Street 1:721 ADAMS ST APT 3
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-2858
Practice Address - Country:US
Practice Address - Phone:716-472-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ223-003103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist