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General NPI Number Information
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NPI Number | 1508688581
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Entity Type | Individual
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Provider Name | CHRISTINA NELSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 95 CENTRAL AVENUE
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City | DEER PARK
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State | NY
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Zip | 11729
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Country | US
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Telephone | 631-213-0232
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Fax |
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Provider Business Mailing Address
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Address Line | 300 CARLETON AVENUE APT 13102
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City | CENTRAL ISLIP
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State | NY
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Zip | 11722
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Country | US
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Telephone | 516-551-5070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 124279-01
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License Number State | NY
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