MEDICARE: KATHERINE CRESPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780215715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE CRESPO

Provider Business Mailing Address
First Line	:	49 MALONE ST
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-4630
Country	:	US
Telephone Number	:	516-476-8086
Fax Number	:

Provider Business Practice Location Address
First Line	:	2499 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-1396
Country	:	US
Telephone Number	:	516-432-1790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/29/2020

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Directions to “ KATHERINE CRESPO ” Practice Location

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