Healthcare Provider Details

I. General information

NPI: 1134465966
Provider Name (Legal Business Name): KRISTIN JOHNSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 BALLSTON AVE
SARATOGA SPRINGS NY
12866-4723
US

IV. Provider business mailing address

130 BRIGHTMAN RD
MECHANICVILLE NY
12118-2812
US

V. Phone/Fax

Practice location:
  • Phone: 518-587-8008
  • Fax: 518-587-8241
Mailing address:
  • Phone: 518-368-8222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number07833-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: