MEDICARE: KRISTIN JILL ESPOSITA-UBLACKER

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	071449-1	NY
2	1041C0700X	Clinical Social Worker	28396	MD
3	1041C0700X	Clinical Social Worker	000124851	MA

General Provider Information

NPI Number	:	1316223175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN JILL ESPOSITA-UBLACKER

Provider Business Mailing Address
First Line	:	4 BEVERLY DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-2823
Country	:	US
Telephone Number	:	518-428-6630
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 BEVERLY DR
Second Line	:
City	:	WEST SAND LAKE
State	:	NY
Zip	:	12196-2823
Country	:	US
Telephone Number	:	518-428-6630
Fax Number	:

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

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	12/01/2025

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