Provider Demographics
NPI:1740800481
Name:FAR, KRISTIN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:FAR
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 1:100 ENTERPRISE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-2129
Mailing Address - Country:US
Mailing Address - Phone:973-685-6722
Mailing Address - Fax:
Practice Address - Street 1:100 ENTERPRISE DR STE 301
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2129
Practice Address - Country:US
Practice Address - Phone:973-685-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06158900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker