Provider Demographics
NPI:1316729171
Name:RAY-BENNETT, KRISTINA L (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:L
Last Name:RAY-BENNETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:RAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:882 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-7307
Mailing Address - Country:US
Mailing Address - Phone:317-488-1135
Mailing Address - Fax:
Practice Address - Street 1:882 OAKLAWN DR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-7307
Practice Address - Country:US
Practice Address - Phone:317-488-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006955A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical