Healthcare Provider Details

I. General information

NPI: 1023473238
Provider Name (Legal Business Name): KDR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GORDON AVE
LAWRENCE TOWNSHIP NJ
08648-1033
US

IV. Provider business mailing address

PO BOX 6573
LAWRENCE TOWNSHIP NJ
08648-0573
US

V. Phone/Fax

Practice location:
  • Phone: 609-844-0452
  • Fax:
Mailing address:
  • Phone: 609-844-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05537300
License Number StateNJ

VIII. Authorized Official

Name: KRISTINA RAGO SOLOMITA
Title or Position: OWNER
Credential:
Phone: 609-844-0452