Healthcare Provider Details

I. General information

NPI: 1558039826
Provider Name (Legal Business Name): KRISTINA KANE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 S HIGHLAND AVE STE 7
OSSINING NY
10562-5806
US

IV. Provider business mailing address

144 S HIGHLAND AVE STE 7
OSSINING NY
10562-5806
US

V. Phone/Fax

Practice location:
  • Phone: 914-987-6046
  • Fax: 914-432-8646
Mailing address:
  • Phone: 914-987-6046
  • Fax: 914-432-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTINA KANE
Title or Position: PROVIDER/OWNER
Credential: LCSW-R
Phone: 914-987-6046