Provider Demographics
NPI:1134671795
Name:STOCKWELL, KRISTI (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX PSYCH-CPEP
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-1409
Mailing Address - Country:US
Mailing Address - Phone:585-275-0478
Mailing Address - Fax:585-273-1130
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX PSYCH-CPEP
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-1409
Practice Address - Country:US
Practice Address - Phone:585-275-0478
Practice Address - Fax:585-273-1130
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR073219-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical