Provider Demographics
NPI:1255100749
Name:AGUAYO, KRYSTAL (LCSW)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:AGUAYO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6643
Mailing Address - Country:US
Mailing Address - Phone:973-963-4156
Mailing Address - Fax:
Practice Address - Street 1:526 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6643
Practice Address - Country:US
Practice Address - Phone:973-963-4156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062627001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical