Provider Demographics
NPI:1316223175
Name:ESPOSITA-UBLACKER, KRISTIN JILL
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JILL
Last Name:ESPOSITA-UBLACKER
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 1:11 SYLVAN LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8542
Mailing Address - Country:US
Mailing Address - Phone:518-283-4417
Mailing Address - Fax:
Practice Address - Street 1:11 SYLVAN LN
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8542
Practice Address - Country:US
Practice Address - Phone:518-283-4417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071449-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical