Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 023943 | NY |
N | 103T00000X | Psychologist | 023943 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 023943 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 023943 | NY |
Y | 103G00000X | Clinical Psychologist | 023943 | NY |
Y | 103TC0700X | Clinical Psychologist | 023943 | NY |
N | 103TC1900X | Counseling Psychologist | 023943 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 023943 | NY |
N | 103TF0000X | Family Psychologist | 023943 | NY |
N | 103TH0004X | Health Psychologist | 023943 | NY |
N | 103TP2701X | Group Psychotherapist | 023943 | NY |
NPI | 1194323618 |
---|---|
Provider Name | Dr. Crista Elizabeth Maracic |
First Address | Stony Brook, NY 11790-0989 |
Second Address | Stony Brook, NY 11794-8790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 16/10/2020 |