=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033448519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIN ELIZABETH MILLS LCSW-R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2009
-----------------------------------------------------
Last Update Date | 12/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 834 KENWOOD AVE STE 3
-----------------------------------------------------
City | SLINGERLANDS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12159-9601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-813-4526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 834 KENWOOD AVE STE 3
-----------------------------------------------------
City | SLINGERLANDS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12159-9601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-813-4526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 076752-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------