Provider Demographics
NPI:1376691923
Name:SEASHORE, KRISTEN M (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:M
Last Name:SEASHORE
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 1:168 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2261
Mailing Address - Country:US
Mailing Address - Phone:617-846-7243
Mailing Address - Fax:
Practice Address - Street 1:168 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2261
Practice Address - Country:US
Practice Address - Phone:617-846-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1000321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA100032OtherLICSW