Provider Demographics
NPI:1417185380
Name:GRASSO, KRISTIN M (PSY D)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:GRASSO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 J N PEASE PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4513
Mailing Address - Country:US
Mailing Address - Phone:704-503-3535
Mailing Address - Fax:704-593-5555
Practice Address - Street 1:1923 J N PEASE PL
Practice Address - Street 2:SUITE 204
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4513
Practice Address - Country:US
Practice Address - Phone:704-503-3535
Practice Address - Fax:704-593-5555
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04475103TC0700X
NC4010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical