Provider Demographics
NPI:1215455811
Name:FASOLINO, CRISTINA MARIE (MPS)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIE
Last Name:FASOLINO
Suffix:
Gender:F
Credentials:MPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WHITEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10805-1209
Mailing Address - Country:US
Mailing Address - Phone:914-552-1464
Mailing Address - Fax:
Practice Address - Street 1:57 WHITEWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10805-1209
Practice Address - Country:US
Practice Address - Phone:914-552-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency