Provider Demographics
NPI:1396858866
Name:CONSIGLIO, KRISTINE S (LCSW-R)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:S
Last Name:CONSIGLIO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:KRISTINE
Other - Last Name:SORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3268 EVERGREEN CIR
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:NY
Mailing Address - Zip Code:14568-9426
Mailing Address - Country:US
Mailing Address - Phone:315-986-3145
Mailing Address - Fax:
Practice Address - Street 1:3019 COUNTY COMPLEX DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-9505
Practice Address - Country:US
Practice Address - Phone:585-396-4363
Practice Address - Fax:585-396-4993
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0693081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYEMOtherEXCELLUS
NY103283EUOtherPREFERRED CARE
NY07300069308Medicaid
NY3109089OtherVALUE OPTIONS
NYP36147Medicare UPIN
NY07300069308Medicaid