MEDICARE: DR. CHRISTINE CAROL BORELLI PHD

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	103T00000X	Psychologist	SS772	FL
2	103T00000X	Psychologist	018385	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598978322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINE CAROL BORELLI PHD

Provider Business Mailing Address
First Line	:	PO BOX 1605
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0058
Country	:	US
Telephone Number	:	631-903-7886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3297 NOYAC RD
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-1942
Country	:	US
Telephone Number	:	631-903-7886
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	09/12/2014

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