Provider Demographics
NPI:1457706780
Name:SANDERSON, KRISTEN (LMHC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:886 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-4010
Mailing Address - Country:US
Mailing Address - Phone:718-585-5544
Mailing Address - Fax:
Practice Address - Street 1:886 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4010
Practice Address - Country:US
Practice Address - Phone:718-275-6010
Practice Address - Fax:718-275-6062
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2016-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006160-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health