MEDICARE: KRYSTINA CENTENO MHC-LP

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	101Y00000X	Counselor		NY

General Provider Information

NPI Number	:	1487544763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINA CENTENO MHC-LP

Provider Business Mailing Address
First Line	:	727 N BROADWAY STE C1
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-430-4226
Fax Number	:	631-938-9119

Provider Business Practice Location Address
First Line	:	727 N BROADWAY STE C1
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-2348
Country	:	US
Telephone Number	:	516-430-4226
Fax Number	:	631-938-9119

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

Provider Enumeration Date	:	07/08/2025
Last Update Date	:	04/24/2026

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