Provider Demographics
NPI:1386154524
Name:LANCTO, KRISTEN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:MARIE
Last Name:LANCTO
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 1:877 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3321
Mailing Address - Country:US
Mailing Address - Phone:518-482-8856
Mailing Address - Fax:518-489-5839
Practice Address - Street 1:877 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3321
Practice Address - Country:US
Practice Address - Phone:518-482-8856
Practice Address - Fax:518-489-5839
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101622104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker