MEDICARE: KRISTIN CRONIN BOONE LMFTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MG60842548	WA

General Provider Information

NPI Number	:	1548801285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN CRONIN BOONE LMFTA

Provider Business Mailing Address
First Line	:	334 ERICKSEN AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1854
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	334 ERICKSEN AVE NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-1854
Country	:	US
Telephone Number	:	949-300-0545
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2019
Last Update Date	:	10/03/2019

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