Healthcare Provider Details

I. General information

NPI: 1003460031
Provider Name (Legal Business Name): KRISTA HOJLO MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 BRIAN DR
BROCKTON MA
02301-4601
US

IV. Provider business mailing address

67 BRIAN DR
BROCKTON MA
02301-4601
US

V. Phone/Fax

Practice location:
  • Phone: 508-245-1566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number223131
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: