Provider Demographics
NPI:1629568761
Name:BELANGER, KRISTINA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:R
Last Name:BELANGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WELBY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1132
Mailing Address - Country:US
Mailing Address - Phone:401-662-1267
Mailing Address - Fax:
Practice Address - Street 1:13 WELBY RD
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1132
Practice Address - Country:US
Practice Address - Phone:401-662-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW017731041C0700X
MA2202171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical