Basic Information
| Provider Information | |||||||||
| NPI: | 1780819276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACQUILANO | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14014 ROUTE 31 | ||||||||
| Address2: | |||||||||
| City: | ALBION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144119301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855897066 | ||||||||
| FaxNumber: | 5855896395 | ||||||||
| Practice Location | |||||||||
| Address1: | 14014 ROUTE 31 | ||||||||
| Address2: | |||||||||
| City: | ALBION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144119301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855897066 | ||||||||
| FaxNumber: | 5855896395 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2009 | ||||||||
| LastUpdateDate: | 12/28/2015 | ||||||||
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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 | 1041C0700X | 079145 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.