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General NPI Number Information
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NPI Number | 1215233093
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Entity Type | Individual
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Provider Name | CHRISTINE MARIE ITA PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 01/27/2011
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Provider Practice Location Address
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Address Line | 50 W 90TH ST D4
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City | NEW YORK
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State | NY
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Zip | 10024-1524
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Country | US
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Telephone | 212-799-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 30TH AVENUE AND 75TH STREET THE LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
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City | JACKSON HTS.
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State | NY
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Zip | 11370-1472
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Country | US
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Telephone | 718-350-3251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 069518011
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License Number State | NY
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