Healthcare Provider Details

I. General information

NPI: 1306621966
Provider Name (Legal Business Name): KRISTEN LEIGH VESTA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ASHLEY AVENUE
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

45 ASHLEY AVENUE
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-326-8039
  • Fax: 845-326-8157
Mailing address:
  • Phone: 845-326-8039
  • Fax: 845-326-8157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number118458
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: