Provider Demographics
NPI:1316376304
Name:BROCK, KRISTEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials: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 SAUNDERS ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2414
Mailing Address - Country:US
Mailing Address - Phone:774-254-0963
Mailing Address - Fax:
Practice Address - Street 1:30 MYSTIC ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1155
Practice Address - Country:US
Practice Address - Phone:781-641-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW 2202611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical