Basic Information
| Provider Information | |||||||||
| NPI: | 1144408964 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERMETI | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 218 LIVINGSTON BAY CT | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465443897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742101913 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2955 MCKINLEY AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466152733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742222246 | ||||||||
| FaxNumber: | 5745372652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2008 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 34005110A | IN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.