Provider Demographics
NPI:1619229093
Name:AGNELLO, KRISTEN JUSTINE (LPC, LMHC, NCC, ACS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JUSTINE
Last Name:AGNELLO
Suffix:
Gender:F
Credentials:LPC, LMHC, NCC, ACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-9675
Mailing Address - Country:US
Mailing Address - Phone:973-476-6371
Mailing Address - Fax:
Practice Address - Street 1:107 E MOUNT PLEASANT AVE STE 8
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3038
Practice Address - Country:US
Practice Address - Phone:973-476-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007194-1101YM0800X
NJ37PC00554300101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional