Provider Demographics
NPI:1811441058
Name:BERTSCH, KRISTIN NICOLE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:NICOLE
Last Name:BERTSCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CENTURY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-1149
Mailing Address - Country:US
Mailing Address - Phone:856-380-2400
Mailing Address - Fax:856-234-7870
Practice Address - Street 1:100 CENTURY PKWY STE 140
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1149
Practice Address - Country:US
Practice Address - Phone:856-380-2400
Practice Address - Fax:856-234-7870
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00615100103TC1900X
PAPS018093103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ854181OtherMEDICARE
NJ0700291Medicaid