Provider Demographics
NPI:1609155597
Name:LAVIN, KRISTY MARIE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:MARIE
Last Name:LAVIN
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 1:902 MOUNTAIN VIEW TER
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-4625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:529 ROUTE 515
Practice Address - Street 2:SUITE 204
Practice Address - City:VERNON
Practice Address - State:NJ
Practice Address - Zip Code:07462-3166
Practice Address - Country:US
Practice Address - Phone:973-764-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054295001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical