Provider Demographics
NPI:1063210920
Name:SANGIACOMO, KRISTA (LAC)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:
Last Name:SANGIACOMO
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LITTLETON RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-1867
Mailing Address - Country:US
Mailing Address - Phone:862-210-9236
Mailing Address - Fax:
Practice Address - Street 1:140 LITTLETON RD STE 301
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-1867
Practice Address - Country:US
Practice Address - Phone:862-210-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00765700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health