Provider Demographics
NPI:1841423399
Name:CRISCIONE, KYLEE M (LMSW, CASAC)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:M
Last Name:CRISCIONE
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-2116
Mailing Address - Country:US
Mailing Address - Phone:716-883-5344
Mailing Address - Fax:
Practice Address - Street 1:951 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2116
Practice Address - Country:US
Practice Address - Phone:716-883-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00080548104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker