Provider Demographics
NPI:1538757950
Name:HANISCH, KRISTEN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:
Last Name:HANISCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:17 HILTON ST
Mailing Address - Street 2:
Mailing Address - City:PEQUANNOCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07440-1309
Mailing Address - Country:US
Mailing Address - Phone:973-270-4943
Mailing Address - Fax:
Practice Address - Street 1:17 HILTON ST
Practice Address - Street 2:
Practice Address - City:PEQUANNOCK
Practice Address - State:NJ
Practice Address - Zip Code:07440-1309
Practice Address - Country:US
Practice Address - Phone:973-270-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NJ44SC060030001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
44SL06313400OtherOUT OF NETWORK