Provider Demographics
NPI:1578048021
Name:GOTTER, KRISTEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GOTTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VINAL AVE
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4226
Mailing Address - Country:US
Mailing Address - Phone:781-545-7537
Mailing Address - Fax:
Practice Address - Street 1:40 VINAL AVE
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4226
Practice Address - Country:US
Practice Address - Phone:781-545-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1118251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical