Provider Demographics
NPI:1902460249
Name:MOHAMED, KRISTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MOHAMED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:VOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 110
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-0110
Mailing Address - Country:US
Mailing Address - Phone:347-380-0508
Mailing Address - Fax:
Practice Address - Street 1:21 3RD ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2320
Practice Address - Country:US
Practice Address - Phone:845-418-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-23
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical