=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588662043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOLORES MARIE SARNO KRISTOFITS PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4949 LIBERTY LN SUITE 45
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18106-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-471-3620
-----------------------------------------------------
Fax | 215-249-0886
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4949 LIBERTY LN SUITE 45
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18106-9014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-471-3620
-----------------------------------------------------
Fax | 215-249-0886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PS003065L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------