Provider Demographics
NPI:1215233093
Name:ITA, CHRISTINE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:ITA
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 1:30TH AVENUE AND 75TH STREET
Mailing Address - Street 2:THE LEXINGTON CENTER FOR MENTAL HEALTH SERVICES, INC.
Mailing Address - City:JACKSON HTS.
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1472
Mailing Address - Country:US
Mailing Address - Phone:718-350-3251
Mailing Address - Fax:
Practice Address - Street 1:50 W 90TH ST
Practice Address - Street 2:D4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1524
Practice Address - Country:US
Practice Address - Phone:212-799-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069518011103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool