Provider Demographics
NPI:1053990374
Name:STAIR, KRISTEN (PD, MSED)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:STAIR
Suffix:
Gender:F
Credentials:PD, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 OLD ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-1049
Mailing Address - Country:US
Mailing Address - Phone:914-948-7271
Mailing Address - Fax:
Practice Address - Street 1:1606 OLD ORCHARD ST
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-1049
Practice Address - Country:US
Practice Address - Phone:718-948-7271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool