Provider Demographics
NPI:1427299239
Name:SALINES-BRADLEE, KRISTEN M (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:SALINES-BRADLEE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SAINT ANTHONYS LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4262
Mailing Address - Country:US
Mailing Address - Phone:978-283-2702
Mailing Address - Fax:978-283-0743
Practice Address - Street 1:7 SAINT ANTHONYS LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-283-2702
Practice Address - Fax:978-283-0743
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10264321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical