Healthcare Provider Details

I. General information

NPI: 1558467449
Provider Name (Legal Business Name): CHRISTINE H. FEWELL PHD, LCSW, CASAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NICHOLS DR
HASTINGS ON HUDSON NY
10706-3525
US

IV. Provider business mailing address

4 NICHOLS DR
HASTINGS ON HUDSON NY
10706-3525
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-2040
  • Fax:
Mailing address:
  • Phone: 914-478-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR012623-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: