Provider Demographics
NPI:1871942565
Name:CRISCIONE, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:CRISCIONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 ROSELAWN RD
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-3215
Mailing Address - Country:US
Mailing Address - Phone:917-560-7122
Mailing Address - Fax:
Practice Address - Street 1:19 ROSELAWN RD
Practice Address - Street 2:APARTMENT 3
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-3215
Practice Address - Country:US
Practice Address - Phone:917-560-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1111111111104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker