Provider Demographics
NPI:1538642293
Name:KIPNESS, ASHLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:KIPNESS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-1922
Mailing Address - Country:US
Mailing Address - Phone:160-977-4155
Mailing Address - Fax:
Practice Address - Street 1:18 THROCKMORTON LN STE 208
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2570
Practice Address - Country:US
Practice Address - Phone:609-774-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5982103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool