Provider Demographics
NPI:1477092807
Name:TITUS, CHRISTINE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:TITUS
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:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:RETSOF
Mailing Address - State:NY
Mailing Address - Zip Code:14539-0207
Mailing Address - Country:US
Mailing Address - Phone:585-204-2042
Mailing Address - Fax:
Practice Address - Street 1:3681 RETSOF RD
Practice Address - Street 2:
Practice Address - City:RETSOF
Practice Address - State:NY
Practice Address - Zip Code:14539-9800
Practice Address - Country:US
Practice Address - Phone:585-204-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2023-12-13
Deactivation Date:2022-02-05
Deactivation Code:
Reactivation Date:2022-10-20
Provider Licenses
StateLicense IDTaxonomies
NY024669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical