Provider Demographics
NPI:1306083811
Name:EL KHATTABI, KRISTEN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:EL KHATTABI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:TUESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1OO CAMBRIDGE ST
Mailing Address - Street 2:FLOOR 14
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-834-3056
Mailing Address - Fax:
Practice Address - Street 1:100 CAMBRIDGE ST FL 14
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2509
Practice Address - Country:US
Practice Address - Phone:832-744-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2153291041C0700X
MA1154931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical