Healthcare Provider Details

I. General information

NPI: 1477092807
Provider Name (Legal Business Name): CHRISTINE M TITUS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date: 02/05/2022
Reactivation Date: 10/20/2022

III. Provider practice location address

3681 RETSOF RD
RETSOF NY
14539-9800
US

IV. Provider business mailing address

PO BOX 207
RETSOF NY
14539-0207
US

V. Phone/Fax

Practice location:
  • Phone: 585-204-2042
  • Fax:
Mailing address:
  • Phone: 585-204-2042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number024669
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: