Healthcare Provider Details

I. General information

NPI: 1497894760
Provider Name (Legal Business Name): KRISTIN A FIUMEFREDDO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 AIR PARK DR
RONKONKOMA NY
11779-7360
US

IV. Provider business mailing address

206 SPRINGMEADOW DR UNIT C
HOLBROOK NY
11741-4111
US

V. Phone/Fax

Practice location:
  • Phone: 631-580-4000
  • Fax:
Mailing address:
  • Phone: 631-868-3762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number2013948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: