Provider Demographics
NPI:1659611945
Name:KREISER, KRISTINA (MA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:
Last Name:KREISER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 S CENTRE AVE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:LEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:19533-8653
Mailing Address - Country:US
Mailing Address - Phone:844-449-7667
Mailing Address - Fax:
Practice Address - Street 1:5 S CENTRE AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8653
Practice Address - Country:US
Practice Address - Phone:844-449-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health