Provider Demographics
NPI:1942269055
Name:MATTIE, KRISTIN DEPRINCE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:DEPRINCE
Last Name:MATTIE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CENTENNIAL BLVD
Mailing Address - Street 2:SUITE M
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4689
Mailing Address - Country:US
Mailing Address - Phone:856-325-6716
Mailing Address - Fax:856-325-6777
Practice Address - Street 1:2 COOPER PLZ
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-735-6339
Practice Address - Fax:856-735-6488
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
99084170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS