Provider Demographics
NPI:1275205981
Name:GREIDER, KRISTINA JOAN
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOAN
Last Name:GREIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-1903
Mailing Address - Country:US
Mailing Address - Phone:570-985-5633
Mailing Address - Fax:
Practice Address - Street 1:951 MAIN ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-1903
Practice Address - Country:US
Practice Address - Phone:570-985-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132048104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker