Provider Demographics
NPI:1144372210
Name:FANDL, KRISTIN MOYER (CSWR)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MOYER
Last Name:FANDL
Suffix:
Gender:F
Credentials:CSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MYERS COLNER RD
Mailing Address - Street 2:HOLLOWBROOK SUITE 1B
Mailing Address - City:WAPPINGER FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590
Mailing Address - Country:US
Mailing Address - Phone:845-298-1910
Mailing Address - Fax:845-226-1327
Practice Address - Street 1:15 MYERS COLNER RD
Practice Address - Street 2:HOLLOWBROOK SUITE 1B
Practice Address - City:WAPPINGER FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590
Practice Address - Country:US
Practice Address - Phone:845-298-1910
Practice Address - Fax:845-226-1327
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist