Provider Demographics
NPI:1720228869
Name:SAND, KRISTA HATCH (LICSW, LADC-I)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:HATCH
Last Name:SAND
Suffix:
Gender:F
Credentials:LICSW, LADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WASHINGTON ST
Mailing Address - Street 2:APARTMENT #1708
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1636
Mailing Address - Country:US
Mailing Address - Phone:603-988-6486
Mailing Address - Fax:866-267-6973
Practice Address - Street 1:13 BOWDOIN ST
Practice Address - Street 2:SUITE 1A/B
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4246
Practice Address - Country:US
Practice Address - Phone:603-988-6486
Practice Address - Fax:866-267-6973
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13171041C0700X
NH0843101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)