Provider Demographics
NPI:1376314690
Name:CHRISTIAN WITHERELL NP IN PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CHRISTIAN WITHERELL NP IN PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERELL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:631-335-5541
Mailing Address - Street 1:19995 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-2820
Mailing Address - Country:US
Mailing Address - Phone:631-260-1326
Mailing Address - Fax:
Practice Address - Street 1:19995 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-2820
Practice Address - Country:US
Practice Address - Phone:631-260-1326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty