Provider Demographics
NPI:1689751026
Name:KINCAID, LAURA KRISTIN (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:KRISTIN
Last Name:KINCAID
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 1:219 MAIN ST
Mailing Address - Street 2:APT #5
Mailing Address - City:EVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:02149-5761
Mailing Address - Country:US
Mailing Address - Phone:330-328-3752
Mailing Address - Fax:
Practice Address - Street 1:30 BOSTON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2540
Practice Address - Country:US
Practice Address - Phone:781-592-5691
Practice Address - Fax:781-595-4393
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2136571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical