Healthcare Provider Details

I. General information

NPI: 1841423399
Provider Name (Legal Business Name): KYLEE M CRISCIONE LMSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

IV. Provider business mailing address

951 NIAGARA ST
BUFFALO NY
14213-2116
US

V. Phone/Fax

Practice location:
  • Phone: 716-883-5344
  • Fax:
Mailing address:
  • Phone: 716-883-5344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number00080548
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: