Provider Demographics
NPI:1124404033
Name:SCAGLIONE, KRISTINA (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:SCAGLIONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1834
Mailing Address - Country:US
Mailing Address - Phone:631-475-8641
Mailing Address - Fax:
Practice Address - Street 1:100 MARINERS WAY STE 100
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1848
Practice Address - Country:US
Practice Address - Phone:631-793-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094701104100000X
NY0884791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker