Provider Demographics
NPI:1053347211
Name:TRAHAN, KRISTA A (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:A
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5938 TANNER LN
Mailing Address - Street 2:
Mailing Address - City:STEWARTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17363-8507
Mailing Address - Country:US
Mailing Address - Phone:410-842-7793
Mailing Address - Fax:
Practice Address - Street 1:2914 E JOPPA RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3031
Practice Address - Country:US
Practice Address - Phone:443-461-5320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112271041C0700X
PACW0144351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA072869NKAMedicare ID - Type UnspecifiedLCSW