Provider Demographics
NPI:1922244292
Name:MARX, KRISTEN C (MA, CAGS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:C
Last Name:MARX
Suffix:
Gender:F
Credentials:MA, CAGS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-0010
Mailing Address - Country:US
Mailing Address - Phone:401-440-4604
Mailing Address - Fax:
Practice Address - Street 1:1058 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:PEACE DALE
Practice Address - State:RI
Practice Address - Zip Code:02879-2487
Practice Address - Country:US
Practice Address - Phone:401-440-4604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMC00393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health