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General NPI Number Information
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NPI Number | 1720368723
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Entity Type | Individual
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Provider Name | KRISTINE FATZER DANBACK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2011
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 1511 ROUTE 22 SUITE 128
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City | BREWSTER
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State | NY
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Zip | 10509-4020
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Country | US
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Telephone | 203-313-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 1511 ROUTE 22 SUITE 128
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City | BREWSTER
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State | NY
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Zip | 10509-4020
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Country | US
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Telephone | 203-313-0032
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 019055
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License Number State | NY
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