Provider Demographics
NPI:1902875750
Name:SHULMAN, KRISTIN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:MARY
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:12 ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1954
Mailing Address - Country:US
Mailing Address - Phone:207-761-5612
Mailing Address - Fax:207-662-6234
Practice Address - Street 1:12 ANDOVER RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1954
Practice Address - Country:US
Practice Address - Phone:207-761-5612
Practice Address - Fax:207-662-6234
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW016381041C0700X
MELC127641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI31298-1OtherBCBSRI
RIKM59768Medicaid
RI413281OtherBLUECHIP
RIKM59768Medicaid