Provider Demographics
NPI:1396469482
Name:KRETSCHMER, KRISTEN MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:KRETSCHMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-3302
Mailing Address - Country:US
Mailing Address - Phone:040-133-9052
Mailing Address - Fax:
Practice Address - Street 1:231 OLD TOWER HILL RD STE 201C
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-3708
Practice Address - Country:US
Practice Address - Phone:401-339-0521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW032571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical