Provider Demographics
NPI:1740452705
Name:POWERS, KRISTEN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:135 GOLD STAR BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606
Mailing Address - Country:US
Mailing Address - Phone:508-753-5425
Mailing Address - Fax:
Practice Address - Street 1:135 GOLD STAR BOULEVARD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606
Practice Address - Country:US
Practice Address - Phone:508-459-6472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7321101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health