Provider Demographics
NPI:1942565155
Name:JONES, KRISTIN L (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:JONES
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 1:4060 BRUING ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-2466
Mailing Address - Country:US
Mailing Address - Phone:941-220-8256
Mailing Address - Fax:941-237-5808
Practice Address - Street 1:1620 TAMIAMI TRL
Practice Address - Street 2:STE 216
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4017
Practice Address - Country:US
Practice Address - Phone:941-255-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW101961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical