Provider Demographics
NPI:1356952683
Name:MOONEY, KRISTINA ROSE
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ROSE
Last Name:MOONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 KATIE CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8470
Mailing Address - Country:US
Mailing Address - Phone:610-905-5342
Mailing Address - Fax:
Practice Address - Street 1:1620 BROADWAY
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-3904
Practice Address - Country:US
Practice Address - Phone:610-799-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health