Provider Demographics
NPI:1700012572
Name:HODSHON, KRISTINE L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:L
Last Name:HODSHON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:SUITE 1100/1200
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-566-7036
Mailing Address - Fax:856-566-6108
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:SUITE 1100/1200
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-566-7036
Practice Address - Fax:856-566-6108
Is Sole Proprietor?:No
Enumeration Date:2009-06-06
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ35SI00560400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0512591Medicaid