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NPI Code Detail

MEDICARE: KRISTINA LYNN MANCHESTER LMSW

MEDICARE: KRISTINA LYNN MANCHESTER 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
1104100000XSocial Worker107177NY

General Provider Information

NPI Number : 1649818568
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA LYNN MANCHESTER LMSW
Provider Business Mailing Address
First Line : 1001 WEST ST
Second Line :
City : CARTHAGE
State : NY
Zip : 13619-9776
Country : US
Telephone Number : 315-493-1000
Fax Number : 315-493-0105
Provider Business Practice Location Address
First Line : 650 STATE ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2839
Country : US
Telephone Number : 315-755-1251
Fax Number : 315-291-6601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2019
Last Update Date : 06/13/2024

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Directions to “ KRISTINA LYNN MANCHESTER LMSW” Practice Location

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