Provider Demographics
NPI:1467960112
Name:QUATTROCHI, KRISTI (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:QUATTROCHI
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 SONJA DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-6727
Mailing Address - Country:US
Mailing Address - Phone:402-499-6219
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL DR STE 203
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:859-699-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5691101YM0800X
NE2887101YM0800X
KY2563831041C0700X
NE20491041C0700X
TN80111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027607100Medicaid