Basic Information
| Provider Information | |||||||||
| NPI: | 1114249695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERCONE | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 GATES CIR | ||||||||
| Address2: | MILLARD FILLMORE GATES HOSPITAL (CHILD PSYC) 8TH FLOOR | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168875792 | ||||||||
| FaxNumber: | 7168875801 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 GATES CIR | ||||||||
| Address2: | MILLARD FILLMORE GATES HOSPITAL (CHILD PSYC) 8TH FLOOR | ||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142091120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168875792 | ||||||||
| FaxNumber: | 7168875801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2010 | ||||||||
| LastUpdateDate: | 02/24/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 018043-1 | NY | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.