Provider Demographics
NPI:1457839458
Name:AMICANGIOLI, KRISTEN MARIE
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:AMICANGIOLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2407
Mailing Address - Country:US
Mailing Address - Phone:617-528-8211
Mailing Address - Fax:
Practice Address - Street 1:99 TOPEKA ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2717
Practice Address - Country:US
Practice Address - Phone:617-528-8211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)