Provider Demographics
NPI:1578856605
Name:PRINDLE, KRISTINE BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:BETH
Last Name:PRINDLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 STAFFORD AVE
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1152
Mailing Address - Country:US
Mailing Address - Phone:315-430-0253
Mailing Address - Fax:
Practice Address - Street 1:191 STAFFORD AVE
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480-1152
Practice Address - Country:US
Practice Address - Phone:315-430-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054819104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker