Provider Demographics
NPI:1972643971
Name:THORESEN, KRISTINE JOY (LICSW, DCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:JOY
Last Name:THORESEN
Suffix:
Gender:F
Credentials:LICSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MILLWAY
Mailing Address - Street 2:P.O. BOX 312
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-1102
Mailing Address - Country:US
Mailing Address - Phone:508-362-4416
Mailing Address - Fax:
Practice Address - Street 1:275 MILLWAY
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630-1102
Practice Address - Country:US
Practice Address - Phone:508-362-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10158591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA007775OtherPACIFIC CARE PROVIDER #
MA760845OtherTUFTS PROVIDER NUMBER
MAPO4675OtherBC BS PROVIDER NUMBER
MA008278OtherVALUE OPTIONS PROVIDER #
MA1891910OtherMBHP PROVIDER NUMBER
MA358812OtherMAGELLAN PROVIDER NUMBER
MAPO4675OtherBC BS PROVIDER NUMBER