Provider Demographics
NPI:1407439797
Name:MANICH, KRISTINA CATHERINE (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:CATHERINE
Last Name:MANICH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2963
Mailing Address - Country:US
Mailing Address - Phone:914-531-4476
Mailing Address - Fax:888-649-3528
Practice Address - Street 1:1008 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2963
Practice Address - Country:US
Practice Address - Phone:914-531-4476
Practice Address - Fax:888-649-3528
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY403651363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty