Provider Demographics
NPI:1730330853
Name:KASERMAN, KRISTIN ELEANOR (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELEANOR
Last Name:KASERMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5697 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4850
Mailing Address - Country:US
Mailing Address - Phone:505-385-0559
Mailing Address - Fax:
Practice Address - Street 1:811 N HARRISVILLE RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:UT
Practice Address - Zip Code:84404
Practice Address - Country:US
Practice Address - Phone:801-399-1818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9330898-3902106H00000X
NM0103331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist