Provider Demographics
NPI:1285709659
Name:PANICCIA, KRISTEN ANN (CASAC-T)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:ANN
Last Name:PANICCIA
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12303-2709
Mailing Address - Country:US
Mailing Address - Phone:518-465-9345
Mailing Address - Fax:518-426-1079
Practice Address - Street 1:900 LARK DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1300
Practice Address - Country:US
Practice Address - Phone:518-465-9345
Practice Address - Fax:518-426-1079
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor