Provider Demographics
NPI:1245112846
Name:CRISPINO, LOIS
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:
Last Name:CRISPINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-1614
Mailing Address - Country:US
Mailing Address - Phone:718-702-3264
Mailing Address - Fax:
Practice Address - Street 1:125 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:LAKE HOPATCONG
Practice Address - State:NJ
Practice Address - Zip Code:07849-1614
Practice Address - Country:US
Practice Address - Phone:718-702-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician