Provider Demographics
NPI:1821382607
Name:WEEKLEY, KRISTIN MARIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIA
Last Name:WEEKLEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREYSTONE RD
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1208
Mailing Address - Country:US
Mailing Address - Phone:781-454-8493
Mailing Address - Fax:
Practice Address - Street 1:5 GREYSTONE RD
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-1208
Practice Address - Country:US
Practice Address - Phone:781-454-8493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1155051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical