Provider Demographics
NPI:1245661131
Name:VERDEROSA, KRISTYN TESSA-MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTYN
Middle Name:TESSA-MARIE
Last Name:VERDEROSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 METROPLEX DR
Mailing Address - Street 2:METROPLEX CORPORATE CENTER,SUITE 200
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2684
Mailing Address - Country:US
Mailing Address - Phone:732-235-8400
Mailing Address - Fax:
Practice Address - Street 1:100 METROPLEX DR
Practice Address - Street 2:METROPLEX CORPORATE CENTER,SUITE 200
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2684
Practice Address - Country:US
Practice Address - Phone:732-235-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055225001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4144007Medicaid
NJ31-4011Medicare PIN