Provider Demographics
NPI:1942841481
Name:NELSON, KRISTA (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:NELSON
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 1:145 PALISADE ST STE 412A
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1680
Mailing Address - Country:US
Mailing Address - Phone:914-228-5005
Mailing Address - Fax:
Practice Address - Street 1:145 PALISADE ST STE 412A
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1680
Practice Address - Country:US
Practice Address - Phone:914-228-5005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist