Healthcare Provider Details

I. General information

NPI: 1225486590
Provider Name (Legal Business Name): KRISTIN MARCIN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 TERHUNE RD
CLARK NJ
07066-2312
US

IV. Provider business mailing address

45 TERHUNE RD
CLARK NJ
07066-2312
US

V. Phone/Fax

Practice location:
  • Phone: 732-609-7290
  • Fax:
Mailing address:
  • Phone: 732-609-7290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00489500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: