Provider Demographics
NPI:1598978322
Name:BORELLI, CHRISTINE CAROL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CAROL
Last Name:BORELLI
Suffix:
Gender:F
Credentials:PHD
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 1605
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0058
Mailing Address - Country:US
Mailing Address - Phone:631-903-7886
Mailing Address - Fax:
Practice Address - Street 1:3297 NOYAC RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1942
Practice Address - Country:US
Practice Address - Phone:631-903-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS772103T00000X
NY018385103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03163435Medicaid