Healthcare Provider Details

I. General information

NPI: 1174234843
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL SHORTT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 JESSICA LN
NISKAYUNA NY
12309-3147
US

IV. Provider business mailing address

91 JESSICA LN
NISKAYUNA NY
12309-3147
US

V. Phone/Fax

Practice location:
  • Phone: 518-227-9016
  • Fax:
Mailing address:
  • Phone: 518-227-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: