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General NPI Number Information
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NPI Number | 1144039942
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Entity Type | Individual
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Provider Name | KRISTINA ELLISON LCSW, LCADC
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Gender | Female
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 221 RIVER ST STE 9
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City | HOBOKEN
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State | NJ
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Zip | 07030-5990
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 118 HANSON AVE
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City | PISCATAWAY
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State | NJ
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Zip | 08854-4835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00270900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05719000
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License Number State | NJ
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