Provider Demographics
NPI:1588753313
Name:CRISS-HAGERTY, JULIE ELLEN (PHD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ELLEN
Last Name:CRISS-HAGERTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ELLEN
Other - Last Name:CRISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23504 LYONS AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2500
Mailing Address - Country:US
Mailing Address - Phone:661-287-9751
Mailing Address - Fax:661-255-3751
Practice Address - Street 1:23504 LYONS AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2500
Practice Address - Country:US
Practice Address - Phone:661-287-9751
Practice Address - Fax:661-255-3751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12899103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical