Provider Demographics
NPI:1902137680
Name:PITTS-PALMERTON, KRISTALENE ANNE (LICSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTALENE
Middle Name:ANNE
Last Name:PITTS-PALMERTON
Suffix:
Gender:F
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:KRISTALENE
Other - Middle Name:A
Other - Last Name:STORMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW, LCSW
Mailing Address - Street 1:910 NW NAITO PKWY APT I25
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3741
Mailing Address - Country:US
Mailing Address - Phone:360-259-4934
Mailing Address - Fax:
Practice Address - Street 1:910 NW NAITO PKWY APT I25
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3741
Practice Address - Country:US
Practice Address - Phone:360-259-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000095881041C0700X
ORL138341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical