Provider Demographics
NPI:1669951703
Name:KIERSTEAD, ANNEKE M (LICSW)
Entity type:Individual
Prefix:
First Name:ANNEKE
Middle Name:M
Last Name:KIERSTEAD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1663
Mailing Address - Country:US
Mailing Address - Phone:401-781-0924
Mailing Address - Fax:
Practice Address - Street 1:42 GORHAM ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1418
Practice Address - Country:US
Practice Address - Phone:401-499-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1007021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical