Provider Demographics
NPI:1487402236
Name:DIONE, KRISTIN MARIE
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:DIONE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:MARIE
Other - Last Name:KRUSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC-T
Mailing Address - Street 1:17515 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-5503
Mailing Address - Country:US
Mailing Address - Phone:718-632-3275
Mailing Address - Fax:
Practice Address - Street 1:3413 VAN PLACE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793
Practice Address - Country:US
Practice Address - Phone:516-289-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)