Provider Demographics
NPI:1366148959
Name:PURYEAR, KRISTIN PAYNE (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:PAYNE
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1410 CRAIN HWY N STE 2B
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-9304
Mailing Address - Country:US
Mailing Address - Phone:410-553-4450
Mailing Address - Fax:
Practice Address - Street 1:1410 CRAIN HWY N STE 2B
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-9304
Practice Address - Country:US
Practice Address - Phone:410-553-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1490216811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical