Provider Demographics
NPI:1992385355
Name:KRISTEN KREIDER LLC
Entity Type:Organization
Organization Name:KRISTEN KREIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KREIDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-474-8993
Mailing Address - Street 1:501 KENILWORTH DR APT T3
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-3876
Mailing Address - Country:US
Mailing Address - Phone:410-474-8993
Mailing Address - Fax:
Practice Address - Street 1:501 KENILWORTH DR APT T3
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3876
Practice Address - Country:US
Practice Address - Phone:410-474-8993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1548716947Medicaid