MEDICARE: DR. CHRISTIE VIRTUE PH.D.

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	010994-2	NY
2	103TC0700X	Clinical Psychologist	010994-2	NY
3	103TC2200X	Clinical Child & Adolescent Psychologist	010994-2	NY
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	010994-2	NY

General Provider Information

NPI Number	:	1902072259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIE VIRTUE PH.D.

Provider Business Mailing Address
First Line	:	2731 NARATH CT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3113
Country	:	US
Telephone Number	:	914-525-2522
Fax Number	:	914-245-9315

Provider Business Practice Location Address
First Line	:	2731 NARATH CT
Second Line	:
City	:	YORKTOWN HEIGHTS
State	:	NY
Zip	:	10598-3113
Country	:	US
Telephone Number	:	914-525-2522
Fax Number	:	914-245-9315

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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