Provider Demographics
NPI:1124466057
Name:GREW, KRISTA (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GREW
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE LIBERTY LANE EAST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-1439
Mailing Address - Country:US
Mailing Address - Phone:603-758-1725
Mailing Address - Fax:
Practice Address - Street 1:ONE LIBERTY LANE EAST
Practice Address - Street 2:SUITE 301
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-1439
Practice Address - Country:US
Practice Address - Phone:603-758-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11421041C0700X
MA1149091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088967Medicaid
0033674Medicare UPIN