Provider Demographics
NPI:1417428814
Name:CRISSON, CARA MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARA
Middle Name:MICHELLE
Last Name:CRISSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 VIP DR
Mailing Address - Street 2:STE 310
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6936
Mailing Address - Country:US
Mailing Address - Phone:412-789-6377
Mailing Address - Fax:
Practice Address - Street 1:4 ALLEGHENY CTR FL 8
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5255
Practice Address - Country:US
Practice Address - Phone:412-789-6377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017946103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty