Provider Demographics
NPI:1073071346
Name:DIGENNARO, CHRISTINE ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:DIGENNARO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AUBURN CT
Mailing Address - Street 2:
Mailing Address - City:S SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1407
Mailing Address - Country:US
Mailing Address - Phone:631-418-7476
Mailing Address - Fax:
Practice Address - Street 1:175 ROUTE 25A STE 10
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2947
Practice Address - Country:US
Practice Address - Phone:631-676-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001499-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist