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Individual
KRISTIN ANN DI VICO
Active
Individual
KRISTIN ANN DI VICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW, MSPT
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
126167-01
NY
2251P0200X
Pediatric Physical Therapist
PT-014318-1
NY
Other
Enumeration date
07/25/2007
Last updated
02/27/2025
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