Provider Demographics
NPI:1114227477
Name:GATOUX, KRISTIN A (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:GATOUX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:WOLFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:230 DUCK POND RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2429
Mailing Address - Country:US
Mailing Address - Phone:919-260-0695
Mailing Address - Fax:
Practice Address - Street 1:230 DUCK POND RD
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2429
Practice Address - Country:US
Practice Address - Phone:919-260-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018841103T00000X
NC00026103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool