Provider Demographics
NPI:1881175610
Name:AMOS, KRISTY (MSW, LISW)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:AMOS
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:JOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4625 MORSE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8355
Mailing Address - Country:US
Mailing Address - Phone:614-383-8381
Mailing Address - Fax:855-259-2615
Practice Address - Street 1:232 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1647
Practice Address - Country:US
Practice Address - Phone:614-636-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2002499104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid