MEDICARE: KRISTA METRINKO LMSW

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	070641	NY

General Provider Information

NPI Number	:	1336454099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA METRINKO LMSW

Provider Business Mailing Address
First Line	:	2 WYANDANCH TRL
Second Line	:
City	:	RIDGE
State	:	NY
Zip	:	11961-2233
Country	:	US
Telephone Number	:	631-848-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 ROUTE 25A
Second Line	:	SECOND FLOOR, SUITE 104
City	:	ROCKY POINT
State	:	NY
Zip	:	11778-8845
Country	:	US
Telephone Number	:	631-924-3741
Fax Number	:

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

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	11/18/2013

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