Provider Demographics
NPI:1922432079
Name:AQUILON-PURPURA, CHRISTINA DANIELLE
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DANIELLE
Last Name:AQUILON-PURPURA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14719 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-3111
Mailing Address - Country:US
Mailing Address - Phone:718-767-0461
Mailing Address - Fax:
Practice Address - Street 1:14719 20TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3111
Practice Address - Country:US
Practice Address - Phone:718-767-0461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY765527131103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist