MEDICARE: KRISTEN DINITTO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	085632-1	NY

General Provider Information

NPI Number	:	1275958126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN DINITTO LCSW

Provider Business Mailing Address
First Line	:	122 WEST ST APT 5F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-1976
Country	:	US
Telephone Number	:	347-668-1490
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 DOBBIN ST STE 305B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-2803
Country	:	US
Telephone Number	:	347-668-1490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2014
Last Update Date	:	03/17/2018

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