Healthcare Provider Details

I. General information

NPI: 1316631849
Provider Name (Legal Business Name): KRISTIN LYNN VISALLI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 COUNTY ROUTE 22
PARISH NY
13131-3339
US

IV. Provider business mailing address

61 DELANO ST
PULASKI NY
13142-1400
US

V. Phone/Fax

Practice location:
  • Phone: 315-625-5210
  • Fax: 315-625-7974
Mailing address:
  • Phone: 315-298-6564
  • Fax: 315-298-7831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number114434
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: