Provider Demographics
NPI:1295041465
Name:CLEAVER, KRISTAL JEAN (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:JEAN
Last Name:CLEAVER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:JEAN
Other - Last Name:LUKACS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3624
Mailing Address - Country:US
Mailing Address - Phone:413-727-5009
Mailing Address - Fax:
Practice Address - Street 1:45 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3624
Practice Address - Country:US
Practice Address - Phone:413-727-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MA118548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker