Healthcare Provider Details

I. General information

NPI: 1316401292
Provider Name (Legal Business Name): CRISTINA CISNEROS PSYCHOLOGY MASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 05/22/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 N. JOHN YOUNG PARKWAY
KISSIMMEE FL
34741
US

IV. Provider business mailing address

530 N 7TH ST
ALLENTOWN PA
18102-2802
US

V. Phone/Fax

Practice location:
  • Phone: 407-910-2941
  • Fax:
Mailing address:
  • Phone: 610-200-5121
  • Fax: 267-712-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: