Provider Demographics
NPI:1598830275
Name:CRISTINO, ANNEMARIE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNEMARIE
Middle Name:
Last Name:CRISTINO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANNEMARIE
Other - Middle Name:
Other - Last Name:LYLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4862 WEST TAFT ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:856-278-3030
Mailing Address - Fax:
Practice Address - Street 1:4862 WEST TAFT ROAD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:856-278-3030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05079400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ551107OtherVALUE OPTIONS INSURANCE