Provider Demographics
NPI:1295864148
Name:MERENDINI, KRISTINA SUHR (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:SUHR
Last Name:MERENDINI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARIA CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2718
Mailing Address - Country:US
Mailing Address - Phone:631-271-4334
Mailing Address - Fax:
Practice Address - Street 1:15 MARIA CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2718
Practice Address - Country:US
Practice Address - Phone:631-271-4334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW PR015835-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN20191Medicare PIN