Provider Demographics
NPI:1912995077
Name:TUSSEY, CHRISCELYN MARIE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CHRISCELYN
Middle Name:MARIE
Last Name:TUSSEY
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 MADISON AVE
Mailing Address - Street 2:FIFTH FLOOR, SUITE 407
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7419
Mailing Address - Country:US
Mailing Address - Phone:646-481-0560
Mailing Address - Fax:888-971-4204
Practice Address - Street 1:99 MADISON AVE
Practice Address - Street 2:FIFTH FLOOR, SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-7419
Practice Address - Country:US
Practice Address - Phone:646-481-0560
Practice Address - Fax:888-971-4204
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103G00000X, 103TF0200X
VA0810003999103T00000X
NY018612103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic