Basic Information
| Provider Information | |||||||||
| NPI: | 1578999819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 422 VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | MONTCLAIR | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070431725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736551990 | ||||||||
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| Practice Location | |||||||||
| Address1: | 654 SPRINGFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079221078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082778900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2013 | ||||||||
| LastUpdateDate: | 09/18/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 44SC05546300 | NJ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.