Provider Demographics
NPI:1821686049
Name:KIERNAN, CHRISTY (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:
Last Name:KIERNAN
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 1:85 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3213
Mailing Address - Country:US
Mailing Address - Phone:617-818-2401
Mailing Address - Fax:
Practice Address - Street 1:16 MEDFORD ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3121
Practice Address - Country:US
Practice Address - Phone:781-777-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1135331041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA113533OtherLICSW