Provider Demographics
NPI:1235476649
Name:STOREY, KRISTI LEE (LMSW)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LEE
Last Name:STOREY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 FAWN MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5237
Mailing Address - Country:US
Mailing Address - Phone:845-750-3017
Mailing Address - Fax:
Practice Address - Street 1:13 FAWN MEADOWS CT
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5237
Practice Address - Country:US
Practice Address - Phone:845-750-3017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088422-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker