Provider Demographics
NPI:1740502921
Name:DAVIN-BOONE, KIRSTEN TRAVERS (LCSW-C)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:TRAVERS
Last Name:DAVIN-BOONE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:TRAVERS
Other - Last Name:DAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:903 SALISBURY WAY
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2761
Mailing Address - Country:US
Mailing Address - Phone:603-343-3723
Mailing Address - Fax:
Practice Address - Street 1:903 SALISBURY WAY
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2761
Practice Address - Country:US
Practice Address - Phone:603-343-3723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH99003227Medicaid
NHNH3227Medicare PIN