Provider Demographics
NPI:1437657095
Name:MAITLAND, KRISTINE M (BS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:M
Last Name:MAITLAND
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1123
Mailing Address - Country:US
Mailing Address - Phone:315-475-1771
Mailing Address - Fax:315-475-4601
Practice Address - Street 1:319 E WATER ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1123
Practice Address - Country:US
Practice Address - Phone:315-475-1771
Practice Address - Fax:315-475-4601
Is Sole Proprietor?:No
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)