Provider Demographics
NPI:1104816909
Name:BOMMARITO, CHRISTY L (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:L
Last Name:BOMMARITO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:L
Other - Last Name:HABERSTROH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:605 SHADYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-6906
Mailing Address - Country:US
Mailing Address - Phone:972-771-2545
Mailing Address - Fax:972-771-2545
Practice Address - Street 1:605 SHADYWOOD LN
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6906
Practice Address - Country:US
Practice Address - Phone:972-771-2545
Practice Address - Fax:972-771-2545
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30538103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0088CYOtherBLUE CROSS/BLUE SHIELD
TX096568301Medicaid
TX096568301Medicaid