Provider Demographics
NPI:1972160216
Name:LAMORTICELLA, KRISTEN M (LSW,LCADC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:M
Last Name:LAMORTICELLA
Suffix:
Gender:F
Credentials:LSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOOD AVE S
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2749
Mailing Address - Country:US
Mailing Address - Phone:732-609-9600
Mailing Address - Fax:
Practice Address - Street 1:313 CEDAR GROVE LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5245
Practice Address - Country:US
Practice Address - Phone:973-647-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06534000104100000X
NJ37CA00141900101YA0400X
NJ37LC00314400101YA0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)