Provider Demographics
NPI:1043879778
Name:DUCHMANN, KRISTINA (MSW-LICENSED)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:DUCHMANN
Suffix:
Gender:F
Credentials:MSW-LICENSED
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:ZHUSHMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2209 GENESEE STREET
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-801-3282
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1656 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4830
Practice Address - Country:US
Practice Address - Phone:315-801-8135
Practice Address - Fax:315-801-8352
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker