Provider Demographics
NPI:1558603548
Name:KIEFFER, MARTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:KIEFFER
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 1:180 WALNUT ST
Mailing Address - Street 2:A52
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-5911
Mailing Address - Country:US
Mailing Address - Phone:973-943-8351
Mailing Address - Fax:
Practice Address - Street 1:855 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1341
Practice Address - Country:US
Practice Address - Phone:973-943-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055137001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical