Provider Demographics
NPI:1265675359
Name:DEMERTZIS, KRISTEN HOPE (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:HOPE
Last Name:DEMERTZIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1134
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-0489
Mailing Address - Country:US
Mailing Address - Phone:516-719-3700
Mailing Address - Fax:516-365-4748
Practice Address - Street 1:1554 NORTHERN BLVD.
Practice Address - Street 2:TRANSITIONS, 3RD FLOOR
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3006
Practice Address - Country:US
Practice Address - Phone:516-719-3700
Practice Address - Fax:516-365-4748
Is Sole Proprietor?:No
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018050103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist