Healthcare Provider Details

I. General information

NPI: 1386370245
Provider Name (Legal Business Name): KRISTA BARLOW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N VILLAGE AVE STE 132
ROCKVILLE CENTRE NY
11570-3763
US

IV. Provider business mailing address

123 GROVE AVE STE 204
CEDARHURST NY
11516-2302
US

V. Phone/Fax

Practice location:
  • Phone: 516-350-8564
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number112206-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: