Provider Demographics
NPI:1285105403
Name:FORMAN, KRISTEN MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:MARIE
Last Name:FORMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:GREANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:115 PINE STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-564-0597
Mailing Address - Fax:201-670-1214
Practice Address - Street 1:115 PINE STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-564-0597
Practice Address - Fax:201-670-1214
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056245001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical