Provider Demographics
NPI:1902646193
Name:KAESE, KRISTIN A (LMHC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:KAESE
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BELLONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:36 FOSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1503
Mailing Address - Country:US
Mailing Address - Phone:631-219-5371
Mailing Address - Fax:
Practice Address - Street 1:14415 68TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1330
Practice Address - Country:US
Practice Address - Phone:973-264-0023
Practice Address - Fax:973-264-0022
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-28
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health