Provider Demographics
NPI:1932479417
Name:MINOTT, KRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MINOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:MOUNT DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660-0081
Mailing Address - Country:US
Mailing Address - Phone:207-812-7073
Mailing Address - Fax:
Practice Address - Street 1:1049 MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT DESERT
Practice Address - State:ME
Practice Address - Zip Code:04660-6318
Practice Address - Country:US
Practice Address - Phone:207-812-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC133231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical