Healthcare Provider Details

I. General information

NPI: 1770630311
Provider Name (Legal Business Name): CHRISTOPHER BRADFORD GATES PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

IV. Provider business mailing address

385 TREMONT AVE
EAST ORANGE NJ
07018-1023
US

V. Phone/Fax

Practice location:
  • Phone: 973-676-1000
  • Fax: 973-395-7016
Mailing address:
  • Phone: 973-676-1000
  • Fax: 973-395-7016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4616
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1486
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: