Provider Demographics
NPI:1497981807
Name:THOMAS J KRISHER, PSYD PC
Entity Type:Organization
Organization Name:THOMAS J KRISHER, PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:315-446-6027
Mailing Address - Street 1:6836 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1024
Mailing Address - Country:US
Mailing Address - Phone:315-446-6027
Mailing Address - Fax:
Practice Address - Street 1:6836 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1024
Practice Address - Country:US
Practice Address - Phone:315-446-6027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009563103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty