Healthcare Provider Details

I. General information

NPI: 1982106191
Provider Name (Legal Business Name): KRISTEN MARIE WOJTUNIAK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN M FERRARO

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 MERRICK AVE
MERRICK NY
11566-3477
US

IV. Provider business mailing address

734 GOULD WAY
YAPHANK NY
11980-2052
US

V. Phone/Fax

Practice location:
  • Phone: 631-891-9076
  • Fax:
Mailing address:
  • Phone: 631-891-9076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number094390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: