Kristen Ottaka, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

011492 Issued in NY

Practice address

3251 Route 112 BLDG 9
Medford, NY 11763-1446

Phone

(631) 451-6007

Fax

(631) 297-8121

NPI assigned

Jul 12, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Passages Wellness & Counseling for Women

  • Clinical Social Worker
  • Setauket, NY
  • NPI 1922416676
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1811569759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3251 ROUTE 112 BLDG 9",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117631446",
            "telephone_number": "631-451-6007",
            "fax_number": "631-297-8121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3251 ROUTE 112 BLDG 9",
            "city": "MEDFORD",
            "state": "NY",
            "postal_code": "117631446",
            "telephone_number": "631-451-6007",
            "fax_number": "631-297-8121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTAKA",
        "first_name": "KRISTEN",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-12",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "011492",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mike C. Oh, PHARMD
• Justin Ohnigian, DDS, MS
• Chioma Okonkwo
• Omega Care & Health,Inc.
• Operation Engage Psychiatric Services
• Our Home Elecrical Contracting Inc.
• Yvonne Daphney Owens, RN
• Olumide Oyeleye
• Crystal Angelica Pacheco, CD/PCD
• Karen Vanessa Padilla, LMSW

• Mental Health Counselor in Medford, NY
• Providers in Medford, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.