Provider Demographics
NPI:1891465571
Name:GIORDANO, KRISTA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:NICOLE
Last Name:GIORDANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EMERTON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4010
Mailing Address - Country:US
Mailing Address - Phone:631-988-0453
Mailing Address - Fax:
Practice Address - Street 1:21 EMERTON ST UNIT 2
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-4010
Practice Address - Country:US
Practice Address - Phone:631-988-0453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2268931041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical