Provider Demographics
NPI:1790030807
Name:PAULSON, KRISTI CHENEY (MSW, LSW,)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:CHENEY
Last Name:PAULSON
Suffix:
Gender:F
Credentials:MSW, LSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3512
Mailing Address - Country:US
Mailing Address - Phone:856-428-1323
Mailing Address - Fax:
Practice Address - Street 1:1200 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3512
Practice Address - Country:US
Practice Address - Phone:856-428-1323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL045438001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical