MEDICARE: KRISTEN STAIR P.D., M.S.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1053990374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN STAIR P.D., M.S.ED.

Provider Business Mailing Address
First Line	:	1606 OLD ORCHARD ST
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-1049
Country	:	US
Telephone Number	:	914-948-7271
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 OLD ORCHARD ST
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-1049
Country	:	US
Telephone Number	:	718-948-7271
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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