Provider Demographics
NPI:1912420134
Name:KRISTAL, STEPHANIE (MA, CH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KRISTAL
Suffix:
Gender:F
Credentials:MA, CH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 BERME RD
Mailing Address - Street 2:
Mailing Address - City:HIGH FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12440-5526
Mailing Address - Country:US
Mailing Address - Phone:845-750-4438
Mailing Address - Fax:
Practice Address - Street 1:275 FAIR ST STE 30
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-3882
Practice Address - Country:US
Practice Address - Phone:845-750-4438
Practice Address - Fax:845-687-6249
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherKINGSTON TRUST FUND