Provider Demographics
NPI:1780774711
Name:DAVIN, KRISTIN M (PSYD)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:DAVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:D
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:164 W 80TH ST
Mailing Address - Street 2:MAIN FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6357
Mailing Address - Country:US
Mailing Address - Phone:917-715-6583
Mailing Address - Fax:
Practice Address - Street 1:164 W 80TH ST
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6357
Practice Address - Country:US
Practice Address - Phone:917-715-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016784103TC0700X
NY019599103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical