Healthcare Provider Details

I. General information

NPI: 1326116047
Provider Name (Legal Business Name): KRISTIN ANN URBINATI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 03/06/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3643 N ROXBORO ST
DURHAM NC
27704-2702
US

IV. Provider business mailing address

3643 N. ROXBORO ST BEHAVIORAL HEALTH OUTPATIENT CENTER
DURHAM NC
27704-3143
US

V. Phone/Fax

Practice location:
  • Phone: 919-470-6413
  • Fax:
Mailing address:
  • Phone: 919-470-6413
  • Fax: 919-681-8627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS21101
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCO11331
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: