Provider Demographics
NPI:1699276923
Name:ALSTON-CLARK, KRYSTINA (LMSW)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:
Last Name:ALSTON-CLARK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E TREMONT AVE APT 8B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5656
Mailing Address - Country:US
Mailing Address - Phone:917-656-2834
Mailing Address - Fax:
Practice Address - Street 1:1970 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5650
Practice Address - Country:US
Practice Address - Phone:917-656-2834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY086275104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker