Provider Demographics
NPI:1548456858
Name:REINCKE, KRISTA MD (LICSW)
Entity type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MD
Last Name:REINCKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:M
Other - Last Name:DUFFY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:149 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3817
Mailing Address - Country:US
Mailing Address - Phone:802-863-2495
Mailing Address - Fax:802-865-0534
Practice Address - Street 1:149 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3817
Practice Address - Country:US
Practice Address - Phone:802-863-2495
Practice Address - Fax:802-865-0534
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900010231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical