Provider Demographics
NPI:1487371084
Name:NICELY COLANGELO, KRISTIN S (LCSW, LCADC, CCS)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:S
Last Name:NICELY COLANGELO
Suffix:
Gender:F
Credentials:LCSW, LCADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1426
Mailing Address - Country:US
Mailing Address - Phone:609-405-7037
Mailing Address - Fax:
Practice Address - Street 1:13 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08108-1426
Practice Address - Country:US
Practice Address - Phone:609-405-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056528001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical