Provider Demographics
NPI:1780003673
Name:STAPLE, KRISTIN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:STAPLE
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 1:55 MEADOW POND RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07419-2509
Mailing Address - Country:US
Mailing Address - Phone:862-268-4670
Mailing Address - Fax:973-726-3775
Practice Address - Street 1:200 WOODPORT RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2628
Practice Address - Country:US
Practice Address - Phone:862-268-4670
Practice Address - Fax:973-726-3775
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055808001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical