Healthcare Provider Details

I. General information

NPI: 1396336079
Provider Name (Legal Business Name): KRISTA FRISZELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 VETERANS MEMORIAL HWY STE 12
COMMACK NY
11725-4300
US

IV. Provider business mailing address

674 BIRCHWOOD PARK DR
MIDDLE ISLAND NY
11953-2631
US

V. Phone/Fax

Practice location:
  • Phone: 631-502-4366
  • Fax:
Mailing address:
  • Phone: 631-502-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number101325
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092522
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: