Healthcare Provider Details

I. General information

NPI: 1730699257
Provider Name (Legal Business Name): KRISTIN LOUISE MAKARA LICSW, MLADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 OVERLOOK DR # C4
AMHERST NH
03031-2830
US

IV. Provider business mailing address

3 OVERLOOK DR # C4
AMHERST NH
03031-2830
US

V. Phone/Fax

Practice location:
  • Phone: 603-229-8367
  • Fax: 603-213-6778
Mailing address:
  • Phone: 603-229-8367
  • Fax: 603-213-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2053
License Number StateNH

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: