Provider Demographics
NPI:1306970272
Name:LONG, KRISTIN (LCAT, LP)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:LCAT, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 14TH ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7208
Mailing Address - Country:US
Mailing Address - Phone:646-425-4999
Mailing Address - Fax:
Practice Address - Street 1:222 W 14TH ST APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7208
Practice Address - Country:US
Practice Address - Phone:646-425-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000360101YM0800X, 221700000X
NY000878102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist