Healthcare Provider Details

I. General information

NPI: 1619582848
Provider Name (Legal Business Name): KRISTIN MICHELLE ETTINGER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 PINE ST STE 330
FLORENCE MA
01062-1256
US

IV. Provider business mailing address

16 COLUMBUS AVE
NORTHAMPTON MA
01060-4224
US

V. Phone/Fax

Practice location:
  • Phone: 413-320-0789
  • Fax:
Mailing address:
  • Phone: 413-320-0789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: