Provider Demographics
NPI:1235715921
Name:CACCAVALE, KRISTIN ANNA (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANNA
Last Name:CACCAVALE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SPRINGFIELD AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2157
Mailing Address - Country:US
Mailing Address - Phone:908-884-5112
Mailing Address - Fax:
Practice Address - Street 1:890 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1218
Practice Address - Country:US
Practice Address - Phone:908-277-8900
Practice Address - Fax:908-508-8919
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00715300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional