Healthcare Provider Details

I. General information

NPI: 1316223175
Provider Name (Legal Business Name): KRISTIN JILL ESPOSITA-UBLACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 BEVERLY DR
WEST SAND LAKE NY
12196-2823
US

IV. Provider business mailing address

4 BEVERLY DR
WEST SAND LAKE NY
12196-2823
US

V. Phone/Fax

Practice location:
  • Phone: 518-428-6630
  • Fax:
Mailing address:
  • Phone: 518-428-6630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number071449-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28396
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000124851
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: