MEDICARE: KRISTEN SANDERSON LMHC

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	101YM0800X	Mental Health Counselor	006160-1	NY

General Provider Information

NPI Number	:	1457706780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN SANDERSON LMHC

Provider Business Mailing Address
First Line	:	886 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4010
Country	:	US
Telephone Number	:	718-585-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	886 WESTCHESTER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-4010
Country	:	US
Telephone Number	:	718-275-6010
Fax Number	:	718-275-6062

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

Provider Enumeration Date	:	04/23/2016
Last Update Date	:	10/02/2016

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