Provider Demographics
NPI:1740615103
Name:BIRCHENOUGH, KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BIRCHENOUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 3RD AVE
Mailing Address - Street 2:SUITE 8C
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2154
Mailing Address - Country:US
Mailing Address - Phone:201-873-9399
Mailing Address - Fax:
Practice Address - Street 1:134 FORT LEE RD
Practice Address - Street 2:LL4
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-2297
Practice Address - Country:US
Practice Address - Phone:201-873-9399
Practice Address - Fax:201-548-5047
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00476400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional