Provider Demographics
NPI:1699433680
Name:SMITH, KRISTEN D (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:SMITH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 ANTHOINE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-4452
Mailing Address - Country:US
Mailing Address - Phone:207-671-7572
Mailing Address - Fax:
Practice Address - Street 1:169 ANTHOINE ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-4452
Practice Address - Country:US
Practice Address - Phone:207-671-7572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW157591041C0700X
CT150131041C0700X
UT14209558-35011041C0700X
MELC22711104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical