Provider Demographics
NPI:1184024226
Name:BRANDT, KRYSTI
Entity Type:Individual
Prefix:
First Name:KRYSTI
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTI
Other - Middle Name:ANN
Other - Last Name:SCHUROTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3516
Mailing Address - Country:US
Mailing Address - Phone:732-331-9845
Mailing Address - Fax:
Practice Address - Street 1:47 WILSON AVE
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1546
Practice Address - Country:US
Practice Address - Phone:732-331-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110026265EMedicaid