Individual provider Active NPI

Kristin Korab Reynolds, LCSW, LCADC

  • Clinical Social Worker
  • Montclair, NJ
National Provider Identifier
1083791735
Registry record updated Sep 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05302900 Issued in NJ
Practice address
303 Claremont Ave FL 2
Montclair, NJ 07042-2813
Phone
(201) 591-5371
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05302900 NJ Primary

Addresses

Primary practice location

303 Claremont Ave FL 2
Montclair, NJ 07042-2813

Mailing address

PO Box 656
Essex Fells, NJ 07021-0656
Phone (201) 591-5371

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091223000031 NJ Practitioner - Clinical Social Worker 3375683337 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

303 Claremont Ave
FL 2
Montclair, NJ 07042-2813
Phone (201) 591-5371

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05302900NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Kristin Korab-Reynolds LLC CurrentSince Dec 1, 2017 Accepting new patients
NJ Behavioral Care Inc. PastSince Nov 1, 2021 Accepting new patients

Locations

303 Claremont Ave
#2
Montclair, NJ 07042
Phone (201) 591-5371

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1083791735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 656",
            "city": "ESSEX FELLS",
            "state": "NJ",
            "postal_code": "070210656",
            "telephone_number": "201-591-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 CLAREMONT AVE FL 2",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070422813",
            "telephone_number": "201-591-5371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORAB REYNOLDS",
        "first_name": "KRISTIN",
        "credential": "LCSW, LCADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05302900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

Verify at the official NPI Registry.