Provider Demographics
NPI:1710510367
Name:MICHAELS, KRISTIN LYN
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYN
Last Name:MICHAELS
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 1:29 MCLEAN ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5631
Mailing Address - Country:US
Mailing Address - Phone:732-997-8075
Mailing Address - Fax:
Practice Address - Street 1:29 MCLEAN ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5631
Practice Address - Country:US
Practice Address - Phone:732-997-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician