Healthcare Provider Details

I. General information

NPI: 1033577861
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH LMSW, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 102ND ST FL 3 D3-216
NEW YORK NY
10029-5204
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL
NEW YORK NY
10029-6504
US

V. Phone/Fax

Practice location:
  • Phone: 347-640-1506
  • Fax: 212-824-2312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number084704-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: