Provider Demographics
NPI:1437456878
Name:CRAIG, KRISTEN E (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:E
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14 WALDO AVE
Mailing Address - Street 2:APT 3R
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4319
Mailing Address - Country:US
Mailing Address - Phone:315-254-5866
Mailing Address - Fax:
Practice Address - Street 1:5 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1812
Practice Address - Country:US
Practice Address - Phone:617-354-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical