1649801184 NPI number — MS. KRISTINE LESLIE DIMARTINO LMFT

Table of content: MS. KRISTINE LESLIE DIMARTINO LMFT (NPI 1649801184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649801184 NPI number — MS. KRISTINE LESLIE DIMARTINO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMARTINO
Provider First Name:
KRISTINE
Provider Middle Name:
LESLIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EVANS
Provider Other First Name:
KRISTINE
Provider Other Middle Name:
LD
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649801184
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
439 NORTH RIVER STREET
Provider Second Line Business Mailing Address:
THE RAINFOREST
Provider Business Mailing Address City Name:
GUILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-623-5574
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NATCHAUG HOSPITAL SACHEM HOUSE
Provider Second Line Business Practice Location Address:
151 STORRS ROAD
Provider Business Practice Location Address City Name:
MANSFIELD CENTER
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-696-9924
Provider Business Practice Location Address Fax Number:
860-456-0021
Provider Enumeration Date:
02/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2086 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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