Healthcare Provider Details

I. General information

NPI: 1033025408
Provider Name (Legal Business Name): KRISTY LYNN WISNIEWSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 WHITEHORSE MERCERVILLE RD
HAMILTON NJ
08619-1953
US

IV. Provider business mailing address

311 WARWICK DR
CREAM RIDGE NJ
08514-2337
US

V. Phone/Fax

Practice location:
  • Phone: 609-219-1600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL05630100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: