Provider Demographics
NPI:1568952299
Name:PANNORFI, KRISTIN L (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:PANNORFI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2909
Mailing Address - Country:US
Mailing Address - Phone:973-432-4068
Mailing Address - Fax:
Practice Address - Street 1:2 W NORTHFIELD RD STE 212
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3758
Practice Address - Country:US
Practice Address - Phone:973-432-4068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI0057600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical