Provider Demographics
NPI:1548046154
Name:FONTENELLE-GARCIA BATIZ, KRISTA J
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:FONTENELLE-GARCIA BATIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 PELHAM PKWY S APT 1B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1107
Mailing Address - Country:US
Mailing Address - Phone:347-440-5467
Mailing Address - Fax:
Practice Address - Street 1:1540 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1106
Practice Address - Country:US
Practice Address - Phone:347-440-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst