Provider Demographics
NPI:1972603538
Name:ORSUCCI, KRISTIN (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:
Last Name:ORSUCCI
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3784
Mailing Address - Country:US
Mailing Address - Phone:603-738-0542
Mailing Address - Fax:603-352-7481
Practice Address - Street 1:20 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3784
Practice Address - Country:US
Practice Address - Phone:603-738-0542
Practice Address - Fax:603-352-7481
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH101Y00000X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30426377Medicaid