Provider Demographics
NPI:1548301534
Name:KYMISSIS, CARISA MAUREEN (MD)
Entity type:Individual
Prefix:DR
First Name:CARISA
Middle Name:MAUREEN
Last Name:KYMISSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 W 113TH ST
Mailing Address - Street 2:#43
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8079
Mailing Address - Country:US
Mailing Address - Phone:347-306-0222
Mailing Address - Fax:
Practice Address - Street 1:526 W 113TH ST
Practice Address - Street 2:#43
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8079
Practice Address - Country:US
Practice Address - Phone:347-306-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60 2396052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry