Provider Demographics
NPI:1144887340
Name:SISTI, KATHLEEN (LMSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SISTI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:811 W JERICHO TPKE STE 106E
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3220
Mailing Address - Country:US
Mailing Address - Phone:631-265-9850
Mailing Address - Fax:631-265-9852
Practice Address - Street 1:811 W JERICHO TPKE STE 106E
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3220
Practice Address - Country:US
Practice Address - Phone:631-265-9850
Practice Address - Fax:631-265-9852
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084188104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker