Provider Demographics
NPI:1518313873
Name:KRISTIN M. O'GARA, MSW, LCSW, LLC
Entity Type:Organization
Organization Name:KRISTIN M. O'GARA, MSW, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:O'GARA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:732-513-8258
Mailing Address - Street 1:617 UNION AVE UNIT 1-11
Mailing Address - Street 2:
Mailing Address - City:BRIELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08730-1839
Mailing Address - Country:US
Mailing Address - Phone:732-513-8258
Mailing Address - Fax:732-223-1427
Practice Address - Street 1:617 UNION AVE UNIT 1-11
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1839
Practice Address - Country:US
Practice Address - Phone:732-513-8258
Practice Address - Fax:732-223-1427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC048110251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health