Provider Demographics
NPI:1245616150
Name:RISOLA, KRISTEN NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:RISOLA
Suffix:
Gender:F
Credentials:PHD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7559 263RD ST
Mailing Address - Street 2:AMBULATORY CARE PAVILION DOOR 2
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1150
Mailing Address - Country:US
Mailing Address - Phone:718-470-8060
Mailing Address - Fax:718-470-1905
Practice Address - Street 1:7559 263RD ST
Practice Address - Street 2:AMBULATORY CARE PAVILION DOOR 2
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1150
Practice Address - Country:US
Practice Address - Phone:718-470-8060
Practice Address - Fax:718-470-1905
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical