Provider Demographics
NPI:1124494562
Name:LIVINGSTON, KIRSTYN (MA)
Entity type:Individual
Prefix:
First Name:KIRSTYN
Middle Name:
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9151 ESTATE THOMAS
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-2617
Mailing Address - Country:US
Mailing Address - Phone:340-774-2228
Mailing Address - Fax:240-714-2258
Practice Address - Street 1:9151 ESTATE THOMAS
Practice Address - Street 2:SUITE 204
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-2617
Practice Address - Country:US
Practice Address - Phone:340-774-2228
Practice Address - Fax:240-714-2258
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI15-036 PSY103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist