Provider Demographics
NPI:1235528068
Name:KINSELEY, CHRISTIANE (LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTIANE
Middle Name:
Last Name:KINSELEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MARSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4106
Mailing Address - Country:US
Mailing Address - Phone:203-434-3266
Mailing Address - Fax:
Practice Address - Street 1:69 MARSDALE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4106
Practice Address - Country:US
Practice Address - Phone:203-434-3266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0069901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical