Healthcare Provider Details

I. General information

NPI: 1033480454
Provider Name (Legal Business Name): CRISTINA MONROY-SIDDALL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BOULEVARD STE 2
KENILWORTH NJ
07033-1611
US

IV. Provider business mailing address

525 BOULEVARD STE 2
KENILWORTH NJ
07033-1611
US

V. Phone/Fax

Practice location:
  • Phone: 908-462-2050
  • Fax:
Mailing address:
  • Phone: 908-462-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05490700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: