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General NPI Number Information
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NPI Number | 1871967828
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Entity Type | Organization
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Legal Business Name | PAUL D. KREISINGER, LCSW, LLC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 1172 E RIDGEWOOD AVE SECOND FLOOR - SUITE 8
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3936
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Country | US
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Telephone | 201-251-2300
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Fax | 201-939-3336
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Provider Business Mailing Address
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Address Line | 51 ELLIOTT PL
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City | RUTHERFORD
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State | NJ
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Zip | 07070-1951
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Country | US
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Telephone | 201-939-3336
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Fax | 201-939-7789
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Authorized Official
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Title or Position | OWNER
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Name | MR. PAUL D KREISINGER
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Credential | LCSW
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Telephone | 201-939-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 44SC05633100
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License Number State | NJ
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