Provider Demographics
NPI:1497432470
Name:MATHESON, KRISTY LYNNE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNNE
Last Name:MATHESON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45327-1356
Mailing Address - Country:US
Mailing Address - Phone:937-469-6929
Mailing Address - Fax:
Practice Address - Street 1:150 W MARKET ST
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:OH
Practice Address - Zip Code:45327-1356
Practice Address - Country:US
Practice Address - Phone:937-469-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-000264211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical