Provider Demographics
NPI:1447046438
Name:MARTINO, KRISTIN ANN (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:MARTINO
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 YARMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3668
Mailing Address - Country:US
Mailing Address - Phone:617-694-7062
Mailing Address - Fax:
Practice Address - Street 1:11 YARMOUTH DR
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3668
Practice Address - Country:US
Practice Address - Phone:617-694-7062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-16
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW019251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical