Provider Demographics
NPI:1780864827
Name:LINDSTROM, CHRISTINA (PHD)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:LINDSTROM
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 1:62 FERRY RD
Mailing Address - Street 2:PO BOX 395
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-1327
Mailing Address - Country:US
Mailing Address - Phone:631-725-8587
Mailing Address - Fax:
Practice Address - Street 1:62 FERRY RD
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-1327
Practice Address - Country:US
Practice Address - Phone:631-725-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000169106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist