Provider Demographics
NPI:1629376470
Name:SMITH, KRISTYN HARRIMAN (LCPC-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTYN
Middle Name:HARRIMAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4254
Mailing Address - Country:US
Mailing Address - Phone:207-862-2384
Mailing Address - Fax:
Practice Address - Street 1:25 MAYO ROAD
Practice Address - Street 2:
Practice Address - City:HAMPDEN
Practice Address - State:ME
Practice Address - Zip Code:04444
Practice Address - Country:US
Practice Address - Phone:207-862-2384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional