Provider Demographics
NPI:1316434418
Name:KATSETOS, KRISTY A (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:A
Last Name:KATSETOS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KRISTY
Other - Middle Name:A
Other - Last Name:KRSULICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 MARION ST APT 47
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4778
Mailing Address - Country:US
Mailing Address - Phone:650-455-6045
Mailing Address - Fax:
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5418
Practice Address - Country:US
Practice Address - Phone:617-582-8604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1205031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical