Provider Demographics
NPI:1477837813
Name:CRISTANTIELLO, SUSAN (ATR, LCAT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CRISTANTIELLO
Suffix:
Gender:F
Credentials:ATR, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 VEATCH ST
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3739
Mailing Address - Country:US
Mailing Address - Phone:845-298-7996
Mailing Address - Fax:
Practice Address - Street 1:8 VEATCH ST
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3739
Practice Address - Country:US
Practice Address - Phone:845-298-7996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000868103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling