Healthcare Provider Details

I. General information

NPI: 1114852928
Provider Name (Legal Business Name): CHRISTINA PISSALIDIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 W BROAD ST
BETHLEHEM PA
18018-5223
US

IV. Provider business mailing address

807 W BROAD ST
BETHLEHEM PA
18018-5223
US

V. Phone/Fax

Practice location:
  • Phone: 610-419-9415
  • Fax:
Mailing address:
  • Phone: 610-419-9415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPS015063
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: