Healthcare Provider Details

I. General information

NPI: 1023408226
Provider Name (Legal Business Name): KRISTINA O'TOOLE-MONTGOMERY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 S UNION ST BUILDING #1 SUITE #110
LAWRENCE MA
01843-2837
US

IV. Provider business mailing address

46A BARTLEY ST
WAKEFIELD MA
01880-3130
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-5070
  • Fax:
Mailing address:
  • Phone: 781-249-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number218797
License Number StateMA

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: