Provider Demographics
NPI:1073252508
Name:LEITE, KRISTINA ELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ELIZABETH
Last Name:LEITE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 DALTON ST # 2R
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-2803
Mailing Address - Country:US
Mailing Address - Phone:401-744-3332
Mailing Address - Fax:
Practice Address - Street 1:205 WATERMAN ST # 202
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4313
Practice Address - Country:US
Practice Address - Phone:401-433-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW010581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical