1720228869 NPI number — KRISTA HATCH SAND LICSW, LADC-I

Table of content: KRISTA HATCH SAND LICSW, LADC-I (NPI 1720228869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720228869 NPI number — KRISTA HATCH SAND LICSW, LADC-I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAND
Provider First Name:
KRISTA
Provider Middle Name:
HATCH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, LADC-I
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720228869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
665 WASHINGTON ST
Provider Second Line Business Mailing Address:
APARTMENT #1708
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02111-1636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-988-6486
Provider Business Mailing Address Fax Number:
866-267-6973

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 BOWDOIN ST
Provider Second Line Business Practice Location Address:
SUITE 1A/B
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02114-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-988-6486
Provider Business Practice Location Address Fax Number:
866-267-6973
Provider Enumeration Date:
03/03/2009

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: 1041C0700X , with the licence number:  1317 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: 0843 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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