Healthcare Provider Details

I. General information

NPI: 1447163530
Provider Name (Legal Business Name): CHRISTEEN VINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 W 12TH ST
DEER PARK NY
11729-6409
US

IV. Provider business mailing address

296 W 12TH ST
DEER PARK NY
11729-6409
US

V. Phone/Fax

Practice location:
  • Phone: 917-831-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: