Provider Demographics
NPI:1336472471
Name:SCHRAG, KRISTINA NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:NICOLE
Last Name:SCHRAG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:KRISTINA
Other - Middle Name:BLACK
Other - Last Name:EMBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:38 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2813
Mailing Address - Country:US
Mailing Address - Phone:401-632-7056
Mailing Address - Fax:
Practice Address - Street 1:382 THAYER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1558
Practice Address - Country:US
Practice Address - Phone:401-330-5882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
RIMHC01370101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health