Provider Demographics
NPI:1225656473
Name:TOUSSAINT, KENNETH JULIAN (LMSW)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JULIAN
Last Name:TOUSSAINT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:TOUSSAINT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:304 FULLER TER
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-2414
Mailing Address - Country:US
Mailing Address - Phone:718-809-4716
Mailing Address - Fax:
Practice Address - Street 1:304 FULLER TER
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-2414
Practice Address - Country:US
Practice Address - Phone:718-809-4716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059257104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker