Provider Demographics
NPI:1295748044
Name:CRISTIANO, RENEE E (LSCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:CRISTIANO
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N WACO AVE
Mailing Address - Street 2:STE 32
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3927
Mailing Address - Country:US
Mailing Address - Phone:316-945-9008
Mailing Address - Fax:316-462-0514
Practice Address - Street 1:815 N WACO AVE
Practice Address - Street 2:STE 32
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3927
Practice Address - Country:US
Practice Address - Phone:316-945-9008
Practice Address - Fax:316-462-0514
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLSCSW4801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS011057OtherBCBS
KS011057Medicare ID - Type Unspecified