Provider Demographics
NPI:1255973905
Name:HOWARD, KRISTINA LEE (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:LEE
Last Name:HOWARD
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:BEACON WELLNESS CENTER PROS
Mailing Address - Street 2:451 FISHKILLE AVE
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508
Mailing Address - Country:US
Mailing Address - Phone:845-831-2124
Mailing Address - Fax:845-831-1373
Practice Address - Street 1:BEACON WELLNESS CENTER PROS
Practice Address - Street 2:451 FISHKILLE AVE
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508
Practice Address - Country:US
Practice Address - Phone:845-831-2124
Practice Address - Fax:845-831-1373
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0884011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical