Provider Demographics
NPI:1770182313
Name:LAURICELLA, KRISTY (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:LAURICELLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2138
Mailing Address - Country:US
Mailing Address - Phone:732-754-5009
Mailing Address - Fax:
Practice Address - Street 1:10 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2419
Practice Address - Country:US
Practice Address - Phone:732-754-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062835001041C0700X
NJSW-GTL-20-013591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical