Provider Demographics
NPI:1144730862
Name:CIPOLLA, KRISTY (MED, NCC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:CIPOLLA
Suffix:
Gender:F
Credentials:MED, NCC
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:RESCHKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC
Mailing Address - Street 1:450 LEEDOM ST APT B
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-2969
Mailing Address - Country:US
Mailing Address - Phone:267-209-3174
Mailing Address - Fax:
Practice Address - Street 1:602 WILLOW ST
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3234
Practice Address - Country:US
Practice Address - Phone:267-209-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-08
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent