Provider Demographics
NPI:1487859393
Name:O'GARA, KRISTIN MISCHLER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MISCHLER
Last Name:O'GARA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 FLORA CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7107
Mailing Address - Country:US
Mailing Address - Phone:732-513-8258
Mailing Address - Fax:732-223-1427
Practice Address - Street 1:617 UNION AVE
Practice Address - Street 2:BUILDING 1 SUITE 11
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1838
Practice Address - Country:US
Practice Address - Phone:732-513-8258
Practice Address - Fax:732-223-1427
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048110001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical