Provider Demographics
NPI:1760905764
Name:DIVITTORE, KRISTA J (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:J
Last Name:DIVITTORE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20971 E SMOKY HILL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5187
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20971 E SMOKY HILL RD STE 204
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-5187
Practice Address - Country:US
Practice Address - Phone:720-347-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10612103T00000X
WAPY60980309103TC0700X
COMSPSY.0000004103TC0700X
HI1742103TC0700X
COPSY.0006288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist