Provider Demographics
NPI:1801584750
Name:DIMARTINO, KRISTIN ELIZABETH (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:KEENEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:232 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-4632
Mailing Address - Country:US
Mailing Address - Phone:716-913-7851
Mailing Address - Fax:
Practice Address - Street 1:232 GLENDALE DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-4632
Practice Address - Country:US
Practice Address - Phone:716-913-7851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064180104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker