Healthcare Provider Details

I. General information

NPI: 1710226311
Provider Name (Legal Business Name): CHRISTENE LYNN MABB LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTENE SMART LMHC

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LEAR JET LN STE 104N
LATHAM NY
12110-2322
US

IV. Provider business mailing address

3 LEAR JET LN STE 104N
LATHAM NY
12110-2322
US

V. Phone/Fax

Practice location:
  • Phone: 518-560-4277
  • Fax: 518-662-4277
Mailing address:
  • Phone: 518-560-4277
  • Fax: 518-662-4277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005392
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: