Provider Demographics
NPI:1659726610
Name:DIMARTINO, KRISTINE NINA (MS)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:NINA
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3823
Mailing Address - Country:US
Mailing Address - Phone:772-320-0778
Mailing Address - Fax:
Practice Address - Street 1:1100 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3823
Practice Address - Country:US
Practice Address - Phone:772-320-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3600339300Medicaid