Provider Demographics
NPI:1649801184
Name:DIMARTINO, KRISTINE LESLIE (LMFT)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:LESLIE
Last Name:DIMARTINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MRS
Other - First Name:KRISTINE
Other - Middle Name:LD
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:439 NORTH RIVER STREET
Mailing Address - Street 2:THE RAINFOREST
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437
Mailing Address - Country:US
Mailing Address - Phone:203-623-5574
Mailing Address - Fax:
Practice Address - Street 1:NATCHAUG HOSPITAL SACHEM HOUSE
Practice Address - Street 2:151 STORRS ROAD
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250
Practice Address - Country:US
Practice Address - Phone:860-696-9924
Practice Address - Fax:860-456-0021
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist