Provider Demographics
NPI:1902619000
Name:KREUTZBERG, KRISTEN MARIE (LAC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:KREUTZBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SPYGLASS CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-4700
Mailing Address - Country:US
Mailing Address - Phone:609-462-4463
Mailing Address - Fax:
Practice Address - Street 1:1514 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1212
Practice Address - Country:US
Practice Address - Phone:800-845-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00853700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health