Provider Demographics
NPI:1659514438
Name:KIRKBRIDE, CHRISTINE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:VALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1289 ROUTE 38
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2730
Mailing Address - Country:US
Mailing Address - Phone:609-267-5656
Mailing Address - Fax:609-867-8892
Practice Address - Street 1:1289 ROUTE 38 STE 203
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036
Practice Address - Country:US
Practice Address - Phone:609-288-3118
Practice Address - Fax:609-835-7962
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 174400000X
NJ44SC056162001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty