Provider Demographics
NPI:1396471504
Name:KRISTEN M DISCEPOLO, LLC
Entity type:Organization
Organization Name:KRISTEN M DISCEPOLO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DISCEPOLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:202-579-0530
Mailing Address - Street 1:11400 ROCKVILLE PIKE # 439
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3004
Mailing Address - Country:US
Mailing Address - Phone:202-579-0530
Mailing Address - Fax:
Practice Address - Street 1:11400 ROCKVILLE PIKE # 439
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3004
Practice Address - Country:US
Practice Address - Phone:202-539-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty