Provider Demographics
NPI:1720549801
Name:CHARALAMBIDIS, KRISTIN D (MA,LAC,NCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:D
Last Name:CHARALAMBIDIS
Suffix:
Gender:F
Credentials:MA,LAC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORBETT WAY
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2283
Mailing Address - Country:US
Mailing Address - Phone:732-210-0509
Mailing Address - Fax:
Practice Address - Street 1:206 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3384
Practice Address - Country:US
Practice Address - Phone:732-210-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00411200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor