=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568952299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN L PANNORFI PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2018
-----------------------------------------------------
Last Update Date | 05/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 W NORTHFIELD RD STE 212
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-3758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-432-4068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 VALLEY RD
-----------------------------------------------------
City | RINGWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07456-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-432-4068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35SI0057600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------