Provider Demographics
NPI:1780815811
Name:MARCALY, KRISTEN HEATHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:HEATHER
Last Name:MARCALY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1618
Mailing Address - Country:US
Mailing Address - Phone:732-920-3434
Mailing Address - Fax:732-920-2447
Practice Address - Street 1:58 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1618
Practice Address - Country:US
Practice Address - Phone:732-920-3434
Practice Address - Fax:732-920-2447
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2780103TC2200X
NJ35SI00607000103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent