Provider Demographics
NPI:1689246498
Name:ACCISANO, KRISTEN SWAIN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SWAIN
Last Name:ACCISANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GARDNERS LN
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3414
Mailing Address - Country:US
Mailing Address - Phone:732-610-2437
Mailing Address - Fax:
Practice Address - Street 1:18 GARDNERS LN
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3414
Practice Address - Country:US
Practice Address - Phone:732-610-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057559001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical