Provider Demographics
NPI:1053428722
Name:KANSIEWICZ, KRISTEN M
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:KANSIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 OXFORD ST
Mailing Address - Street 2:APT.205
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1113
Mailing Address - Country:US
Mailing Address - Phone:781-367-2383
Mailing Address - Fax:
Practice Address - Street 1:113 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-2910
Practice Address - Country:US
Practice Address - Phone:781-367-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health