Provider Demographics
NPI:1073808135
Name:HAMBRIDGE, KRISTIN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:HAMBRIDGE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:SPOONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:14 HOLTON STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 GARRISON RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4445
Practice Address - Country:US
Practice Address - Phone:617-277-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2169371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical