Provider Demographics
NPI:1174914402
Name:MATHIEU, KRISTIN (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MATHIEU
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 1:10225 E EMILY DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-3133
Mailing Address - Country:US
Mailing Address - Phone:520-780-1290
Mailing Address - Fax:
Practice Address - Street 1:10225 E EMILY DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-3133
Practice Address - Country:US
Practice Address - Phone:520-780-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-13740104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker