Healthcare Provider Details

I. General information

NPI: 1548743172
Provider Name (Legal Business Name): KRISTINE HUFFMAN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 DEVON RD
LEE MA
01238-9342
US

IV. Provider business mailing address

335 DEVON RD
LEE MA
01238-9342
US

V. Phone/Fax

Practice location:
  • Phone: 413-429-6952
  • Fax:
Mailing address:
  • Phone: 413-429-6952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113525
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: