Provider Demographics
NPI:1639314222
Name:BOYAN, KRISTEN TOZZI (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:TOZZI
Last Name:BOYAN
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 1:323 STEILEN AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2823
Mailing Address - Country:US
Mailing Address - Phone:201-788-9271
Mailing Address - Fax:
Practice Address - Street 1:323 STEILEN AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2823
Practice Address - Country:US
Practice Address - Phone:201-788-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077636104100000X
NJ44SC054803001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker