Healthcare Provider Details

I. General information

NPI: 1376556878
Provider Name (Legal Business Name): MICHAEL CRISTIANO PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N FEDERAL HWY STE 200
BOCA RATON FL
33432-2813
US

IV. Provider business mailing address

1990 N FEDERAL HWY SUITE C
POMPANO BEACH FL
33062-1032
US

V. Phone/Fax

Practice location:
  • Phone: 954-899-0090
  • Fax:
Mailing address:
  • Phone: 954-788-9399
  • Fax: 954-905-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPY6322
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY6322
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY6322
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6322
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6322
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPY6322
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY6322
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPY6322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: