Provider Demographics
NPI:1003940834
Name:WINTER-GREEN, KRYSTEN (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:KRYSTEN
Middle Name:
Last Name:WINTER-GREEN
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 231035
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02123-1035
Mailing Address - Country:US
Mailing Address - Phone:617-247-0356
Mailing Address - Fax:
Practice Address - Street 1:43 WEST ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1203
Practice Address - Country:US
Practice Address - Phone:508-965-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1075481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20682Medicare ID - Type UnspecifiedPART B