Healthcare Provider Details

I. General information

NPI: 1407049737
Provider Name (Legal Business Name): KRISTINE LEE WILHELMSEN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 11/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 HARTWELL ST STE 307
FALL RIVER MA
02721-3019
US

IV. Provider business mailing address

703 OCEAN MDWS
FAIRHAVEN MA
02719-5232
US

V. Phone/Fax

Practice location:
  • Phone: 774-634-9251
  • Fax: 508-993-1162
Mailing address:
  • Phone: 774-634-9251
  • Fax: 508-993-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: