Provider Demographics
NPI:1316458698
Name:KRISTIN KORAB-REYNOLDS LLC
Entity type:Organization
Organization Name:KRISTIN KORAB-REYNOLDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KORAB-REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-591-5371
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:ESSEX FELLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07021-0656
Mailing Address - Country:US
Mailing Address - Phone:201-591-5371
Mailing Address - Fax:
Practice Address - Street 1:303 CLAREMONT AVE FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2813
Practice Address - Country:US
Practice Address - Phone:201-591-5371
Practice Address - Fax:973-638-1829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SCO5302900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0613801Medicaid