Provider Demographics
NPI:1508913617
Name:MARTINEAU, KRISTY LYNN (MASTER'S LEVEL)
Entity Type:Individual
Prefix:MISS
First Name:KRISTY
Middle Name:LYNN
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:MASTER'S LEVEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 ALDER STREET UNIT #36
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-0531
Mailing Address - Country:US
Mailing Address - Phone:781-577-2744
Mailing Address - Fax:
Practice Address - Street 1:133 E MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2630
Practice Address - Country:US
Practice Address - Phone:508-460-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health