Provider Demographics
NPI:1164056958
Name:KINGSTON, LOGAN ANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:ANNE
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-2041
Mailing Address - Country:US
Mailing Address - Phone:631-255-4453
Mailing Address - Fax:
Practice Address - Street 1:46 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-4864
Practice Address - Country:US
Practice Address - Phone:631-255-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108466104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker