Provider Demographics
NPI:1023571668
Name:DICARLO, KRISTA MARIE (MS MSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIE
Last Name:DICARLO
Suffix:
Gender:F
Credentials:MS MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 WORTHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-4027
Mailing Address - Country:US
Mailing Address - Phone:413-734-5376
Mailing Address - Fax:413-737-7949
Practice Address - Street 1:153 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4016
Practice Address - Country:US
Practice Address - Phone:844-642-9355
Practice Address - Fax:413-732-0309
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty