Provider Demographics
NPI:1871967828
Name:PAUL D. KREISINGER, LCSW, LLC
Entity type:Organization
Organization Name:PAUL D. KREISINGER, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:KREISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-939-3336
Mailing Address - Street 1:51 ELLIOTT PL
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1951
Mailing Address - Country:US
Mailing Address - Phone:201-939-3336
Mailing Address - Fax:201-939-7789
Practice Address - Street 1:1172 E RIDGEWOOD AVE
Practice Address - Street 2:SECOND FLOOR - SUITE 8
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3936
Practice Address - Country:US
Practice Address - Phone:201-251-2300
Practice Address - Fax:201-939-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05633100261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health