Provider Demographics
NPI:1871212621
Name:DEPOLO, KRISITN STRETANSKI (MS CRC)
Entity type:Individual
Prefix:
First Name:KRISITN
Middle Name:STRETANSKI
Last Name:DEPOLO
Suffix:
Gender:F
Credentials:MS CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 HORSE SHOE TRL
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9559
Mailing Address - Country:US
Mailing Address - Phone:610-724-4530
Mailing Address - Fax:
Practice Address - Street 1:1240 HORSE SHOE TRL
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9559
Practice Address - Country:US
Practice Address - Phone:610-724-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health