Provider Demographics
NPI:1750181244
Name:LANE, KRISTI WITTER (CASAC-T; BS)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:WITTER
Last Name:LANE
Suffix:
Gender:
Credentials:CASAC-T; BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WAVERLY ST
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1038
Mailing Address - Country:US
Mailing Address - Phone:845-522-7911
Mailing Address - Fax:
Practice Address - Street 1:2000 MAPLE HILL ST STE 101
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4122
Practice Address - Country:US
Practice Address - Phone:914-977-0608
Practice Address - Fax:914-962-5102
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39971101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)