Provider Demographics
NPI:1497803357
Name:KISLIN, NANCY JO (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:KISLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:KISLIN
Other - Last Name:FLAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 CHAUCER RD
Mailing Address - Street 2:
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2901
Mailing Address - Country:US
Mailing Address - Phone:973-912-0391
Mailing Address - Fax:
Practice Address - Street 1:6 CHAUCER RD
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2901
Practice Address - Country:US
Practice Address - Phone:973-912-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ33SC014517001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical