Healthcare Provider Details

I. General information

NPI: 1215703574
Provider Name (Legal Business Name): KRISTINE CREAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 PARADISE RD # 1114
SALEM MA
01970-4229
US

IV. Provider business mailing address

17 PARADISE RD VINNIN SQUARE PLAZA #1114
SALEM MA
01970-4229
US

V. Phone/Fax

Practice location:
  • Phone: 617-299-6578
  • Fax:
Mailing address:
  • Phone: 617-299-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1141877
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: