Provider Demographics
NPI:1992057228
Name:CIRCELLI, KRISTA LEIGH (LMSW)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEIGH
Last Name:CIRCELLI
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 1:10 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2306
Mailing Address - Country:US
Mailing Address - Phone:315-725-1746
Mailing Address - Fax:
Practice Address - Street 1:1500 GENESEE STREET
Practice Address - Street 2:MENTAL HEALTH CONNECTIONS
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5104
Practice Address - Country:US
Practice Address - Phone:315-735-9501
Practice Address - Fax:315-735-9769
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087659101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health