Provider Demographics
NPI:1851538524
Name:MCAULIFFE, KRISTIN MICHELLE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:MCAULIFFE
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 1:1308 FISKE RD
Mailing Address - Street 2:
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-2033
Mailing Address - Country:US
Mailing Address - Phone:518-846-3700
Mailing Address - Fax:
Practice Address - Street 1:1308 FISKE RD
Practice Address - Street 2:
Practice Address - City:CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12921-2033
Practice Address - Country:US
Practice Address - Phone:518-846-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY624738051103TS0200X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No252Y00000XAgenciesEarly Intervention Provider Agency