Healthcare Provider Details

I. General information

NPI: 1013891068
Provider Name (Legal Business Name): CHRISTAL ST. CLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 HADDONFIELD RD STE 110
PENNSAUKEN NJ
08109-3376
US

IV. Provider business mailing address

4235 TERRACE AVE
PENNSAUKEN NJ
08109-1627
US

V. Phone/Fax

Practice location:
  • Phone: 856-406-0035
  • Fax:
Mailing address:
  • Phone: 862-622-9381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: