Provider Demographics
NPI:1912784174
Name:AVELLUTO, KRISTINE MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:MARIE
Last Name:AVELLUTO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NE 93RD ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-3325
Mailing Address - Country:US
Mailing Address - Phone:816-885-9869
Mailing Address - Fax:
Practice Address - Street 1:6950 SQUIBB RD STE 430
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3258
Practice Address - Country:US
Practice Address - Phone:913-222-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW13199104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker