Provider Demographics
NPI:1730310863
Name:MEADOW, KRISTINA S (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:S
Last Name:MEADOW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:S
Other - Last Name:MISSBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:20 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953-3029
Mailing Address - Country:US
Mailing Address - Phone:207-399-7978
Mailing Address - Fax:202-330-4562
Practice Address - Street 1:20 HIGH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953
Practice Address - Country:US
Practice Address - Phone:207-922-9252
Practice Address - Fax:202-330-4562
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC132871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical