Provider Demographics
NPI:1972813178
Name:ANTONIO, KRISTEN MALIA (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MALIA
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:MALIA
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:276 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2948
Mailing Address - Country:US
Mailing Address - Phone:978-760-0098
Mailing Address - Fax:
Practice Address - Street 1:383 ELLIOT ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02464-1126
Practice Address - Country:US
Practice Address - Phone:617-564-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4784471041S0200X
174400000X
MA11000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No174400000XOther Service ProvidersSpecialist