Provider Demographics
NPI:1710904453
Name:KLOSTERMANN, CHRISTINE S (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:S
Last Name:KLOSTERMANN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 MARRETT RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-7936
Mailing Address - Country:US
Mailing Address - Phone:781-861-7365
Mailing Address - Fax:
Practice Address - Street 1:343 MARRETT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-7936
Practice Address - Country:US
Practice Address - Phone:781-861-7365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPPO133OtherBLUE CROSS/BLUE SHIELD
MA1891961OtherMASS BEHAVIORAL PARTNERSH
MAPPO133Medicare ID - Type Unspecified