Provider Demographics
NPI:1104694066
Name:HANLEY, KRISTIE (PSYD, LPC)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 WOODLAND AVE APT 37
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-2173
Mailing Address - Country:US
Mailing Address - Phone:973-769-0036
Mailing Address - Fax:
Practice Address - Street 1:139 SOUTH ST STE 205C
Practice Address - Street 2:
Practice Address - City:NEW PROVIDENCE
Practice Address - State:NJ
Practice Address - Zip Code:07974-1999
Practice Address - Country:US
Practice Address - Phone:973-769-0036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00999200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional