Provider Demographics
NPI:1104408046
Name:SOTO, CHRISTINA (CERTIFIED SCHOOL PSY)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:CERTIFIED SCHOOL PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 LOCUST ST APT 4E
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2630
Mailing Address - Country:US
Mailing Address - Phone:646-713-8180
Mailing Address - Fax:
Practice Address - Street 1:673 LOCUST ST APT 4E
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2630
Practice Address - Country:US
Practice Address - Phone:646-713-8180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2023-02-06
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2023-02-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool