Provider Demographics
NPI:1356719686
Name:KRISTIN SOLBERG, LCSW, LLC.
Entity type:Organization
Organization Name:KRISTIN SOLBERG, LCSW, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CEDS
Authorized Official - Phone:407-340-1708
Mailing Address - Street 1:1345 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5404
Mailing Address - Country:US
Mailing Address - Phone:407-340-1708
Mailing Address - Fax:407-641-9245
Practice Address - Street 1:1345 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5404
Practice Address - Country:US
Practice Address - Phone:407-340-1708
Practice Address - Fax:407-641-9245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005455300Medicaid