Provider Demographics
NPI:1255662946
Name:ALTWIES, KRISTINE M (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:ALTWIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GRANDVIEW AVENUE
Mailing Address - Street 2:BEHAVIORAL HEALTH WATERBURY HOSPITAL
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708
Mailing Address - Country:US
Mailing Address - Phone:203-573-6103
Mailing Address - Fax:203-573-7240
Practice Address - Street 1:88 GRANDVIEW AVENUE
Practice Address - Street 2:BEHAVIORAL HEALTH WATERBURY HOSPITAL
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-573-6103
Practice Address - Fax:203-573-7240
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical