Provider Demographics
NPI:1275168155
Name:NEAGLE, KRISTIN M (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:M
Last Name:NEAGLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 EAST GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2129
Mailing Address - Country:US
Mailing Address - Phone:315-218-0855
Mailing Address - Fax:315-478-3118
Practice Address - Street 1:420 EAST GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2129
Practice Address - Country:US
Practice Address - Phone:315-218-0855
Practice Address - Fax:315-478-3118
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001829-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health