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General NPI Number Information
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NPI Number | 1316458698
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Entity Type | Organization
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Legal Business Name | KRISTIN KORAB-REYNOLDS LLC
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Dates
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Enumeration Date | 10/13/2017
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 303 CLAREMONT AVE FL 2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2813
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Country | US
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Telephone | 201-591-5371
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Fax | 973-638-1829
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Provider Business Mailing Address
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Address Line | PO BOX 656
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City | ESSEX FELLS
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State | NJ
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Zip | 07021-0656
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Country | US
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Telephone | 201-591-5371
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | KRISTIN KORAB-REYNOLDS
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Credential | LCSW
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Telephone | 201-591-5371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SCO5302900
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License Number State | NJ
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