Provider Demographics
NPI:1053621359
Name:SANDERSON, KRYSTYNA (PSYD, NCPSYA, LP)
Entity type:Individual
Prefix:
First Name:KRYSTYNA
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:PSYD, NCPSYA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W 29TH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4504
Mailing Address - Country:US
Mailing Address - Phone:212-725-7850
Mailing Address - Fax:212-689-3212
Practice Address - Street 1:3 W 29TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4504
Practice Address - Country:US
Practice Address - Phone:212-725-7850
Practice Address - Fax:212-689-3212
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000873-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst