Provider Demographics
NPI:1124373089
Name:SMITH, KRISTIN ANNE (LSW)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 SITTLER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-9063
Mailing Address - Country:US
Mailing Address - Phone:610-442-4096
Mailing Address - Fax:
Practice Address - Street 1:193 SITTLER VALLEY RD
Practice Address - Street 2:
Practice Address - City:KUTZTOWN
Practice Address - State:PA
Practice Address - Zip Code:19530-9063
Practice Address - Country:US
Practice Address - Phone:610-442-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125552104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker