Provider Demographics
NPI:1720609472
Name:KRISTINE THEODORA KINGSLEY
Entity Type:Organization
Organization Name:KRISTINE THEODORA KINGSLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:THEODORA
Authorized Official - Last Name:KINGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:917-716-6995
Mailing Address - Street 1:173 HUGUENOT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7710
Mailing Address - Country:US
Mailing Address - Phone:917-716-6995
Mailing Address - Fax:
Practice Address - Street 1:173 HUGUENOT ST STE 200
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-7710
Practice Address - Country:US
Practice Address - Phone:917-716-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty