Provider Demographics
NPI:1679829238
Name:MERCURIO-TORNABENE, KRISTINE (MSEDADVCDCERT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:
Last Name:MERCURIO-TORNABENE
Suffix:
Gender:F
Credentials:MSEDADVCDCERT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SETTING SUN DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5689
Mailing Address - Country:US
Mailing Address - Phone:917-295-4864
Mailing Address - Fax:
Practice Address - Street 1:1723 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6103
Practice Address - Country:US
Practice Address - Phone:718-858-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool