Provider Demographics
NPI:1942256805
Name:TAYLOR, KRISTIN WILSON (LICSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:WILSON
Last Name:TAYLOR
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 1:55 WAREHAM ST
Mailing Address - Street 2:
Mailing Address - City:CARVER
Mailing Address - State:MA
Mailing Address - Zip Code:02330-1716
Mailing Address - Country:US
Mailing Address - Phone:508-280-4825
Mailing Address - Fax:
Practice Address - Street 1:55 WAREHAM ST
Practice Address - Street 2:
Practice Address - City:CARVER
Practice Address - State:MA
Practice Address - Zip Code:02330-1716
Practice Address - Country:US
Practice Address - Phone:508-280-4825
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA1113821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300010OtherVALUE OPTIONS
MAP10283OtherBCBS
MD0300010OtherMBHP
MAMA111382OtherBCBS
MA0300010OtherVALUE OPTIONS