Healthcare Provider Details

I. General information

NPI: 1114129228
Provider Name (Legal Business Name): CHRISTOPHER JAMES ANDERSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 THIRD AVE JWJ COUNSELING CENTER UNION SETTLEMENT ASSOCIATION
NEW YORK NY
10029
US

IV. Provider business mailing address

78-11 35TH AVE #1B
JACKSON HEIGHTS NY
11372
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6171
  • Fax: 212-828-6145
Mailing address:
  • Phone: 212-828-6171
  • Fax: 212-828-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: