Provider Demographics
NPI:1023408226
Name:O'TOOLE-MONTGOMERY, KRISTINA (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:O'TOOLE-MONTGOMERY
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 1:46A BARTLEY ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3130
Mailing Address - Country:US
Mailing Address - Phone:781-249-9088
Mailing Address - Fax:
Practice Address - Street 1:439 S UNION ST
Practice Address - Street 2:BUILDING #1 SUITE #110
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-2837
Practice Address - Country:US
Practice Address - Phone:978-688-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2187971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical