Healthcare Provider Details

I. General information

NPI: 1023815677
Provider Name (Legal Business Name): KRISTIN MARIE STELTER LICSW, MFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 BROADWAY UNIT 3
PROVIDENCE RI
02909-1143
US

IV. Provider business mailing address

341 BROADWAY UNIT 3
PROVIDENCE RI
02909-1143
US

V. Phone/Fax

Practice location:
  • Phone: 401-238-4855
  • Fax: 401-238-4856
Mailing address:
  • Phone: 401-238-4855
  • Fax: 401-238-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1140615
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932018
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04374
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: