Provider Demographics
NPI:1124183793
Name:CARISTIA, LORI (PSYD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:
Last Name:CARISTIA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3306
Mailing Address - Country:US
Mailing Address - Phone:718-522-0788
Mailing Address - Fax:718-522-0788
Practice Address - Street 1:536 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3306
Practice Address - Country:US
Practice Address - Phone:718-522-0788
Practice Address - Fax:718-522-0788
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013678-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY522802OtherVALUEOPTIONS ID NUMBER
NYP2803087OtherOXFORD PROVIDER ID NUMBER