Provider Demographics
NPI:1316945942
Name:KEANE, KRISTINE CANGELOSI (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:CANGELOSI
Last Name:KEANE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:CANGELOSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 JACK MARTIN BLVD STE E2
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7772
Mailing Address - Country:US
Mailing Address - Phone:732-920-3434
Mailing Address - Fax:732-920-2447
Practice Address - Street 1:220 JACK MARTIN BLVD STE E2
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7772
Practice Address - Country:US
Practice Address - Phone:732-920-3434
Practice Address - Fax:732-920-2447
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00424500103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical