Provider Demographics
NPI:1578769931
Name:HARDEN, KRISTIN LEIGH (BA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:HARDEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 NC HIGHWAY 55
Mailing Address - Street 2:STE 105
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7812
Mailing Address - Country:US
Mailing Address - Phone:919-457-1517
Mailing Address - Fax:919-363-7697
Practice Address - Street 1:500 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2135
Practice Address - Country:US
Practice Address - Phone:908-725-2800
Practice Address - Fax:908-704-1790
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0116991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7794703OtherAGENCY PROGRAM MEDICAID NUMBER
NJ0023701Medicaid
NJ527486OtherAGENCY MEDICARE PROVIDER NUMBER