Provider Demographics
NPI:1275921827
Name:ST ONGE, KRYSTIN M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KRYSTIN
Middle Name:M
Last Name:ST ONGE
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WHISPERING PINES DR
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536
Mailing Address - Country:US
Mailing Address - Phone:774-521-7250
Mailing Address - Fax:508-539-0090
Practice Address - Street 1:2 OAK STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:774-521-7250
Practice Address - Fax:508-539-0090
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2190921041C0700X
MA1192241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical