Basic Information
| Provider Information | |||||||||
| NPI: | 1578812236 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRISCOLL | ||||||||
| FirstName: | CHRISTY | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 PAYSON RD | ||||||||
| Address2: | |||||||||
| City: | CORNWALL ON HUDSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125201603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459138753 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 633 GIDNEY AVE STE 6 | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125502805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455692900 | ||||||||
| FaxNumber: | 8666195710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2012 | ||||||||
| LastUpdateDate: | 10/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 163W00000X | 591553-1 | NY | N | Nursing Service Providers | Registered Nurse |
No ID Information.