Provider Demographics
NPI:1669016911
Name:SEPE, KRISTINA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:SEPE
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 1:1737 MAPLELEAF BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2729
Mailing Address - Country:US
Mailing Address - Phone:201-674-9915
Mailing Address - Fax:
Practice Address - Street 1:10204 BODE ST STE B
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-9813
Practice Address - Country:US
Practice Address - Phone:855-241-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW166401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty