Provider Demographics
NPI:1457051435
Name:SHORTELL, KRISTEN (MS, LPC, LPAT ATR-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:SHORTELL
Suffix:
Gender:F
Credentials:MS, LPC, LPAT ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 NEWMAN SPRINGS RD UNIT 327
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-8012
Mailing Address - Country:US
Mailing Address - Phone:732-378-9314
Mailing Address - Fax:
Practice Address - Street 1:39 AVENUE AT THE CMN STE 106
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4560
Practice Address - Country:US
Practice Address - Phone:732-378-9314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00009600221700000X
NJ37PC00846900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist