Healthcare Provider Details

I. General information

NPI: 1255774568
Provider Name (Legal Business Name): KRISTIN ANN PARISE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WASHINGTON STREET
POUGHKEEPSIE NY
12601-9998
US

IV. Provider business mailing address

230 NORTH ROAD
POUGHKEEPSIE NY
12601-9998
US

V. Phone/Fax

Practice location:
  • Phone: 845-486-3680
  • Fax: 845-486-3690
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: