Provider Demographics
NPI:1881474401
Name:KING, KRISTIN L (LSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08879-2437
Mailing Address - Country:US
Mailing Address - Phone:732-887-5915
Mailing Address - Fax:
Practice Address - Street 1:242 OLD NEW BRUNSWICK RD STE 150
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3750
Practice Address - Country:US
Practice Address - Phone:848-297-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL070291001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical