MEDICARE: CHRISTOPHER CARVAJAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1659219715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER CARVAJAL

Provider Business Mailing Address
First Line	:	3675 BROADWAY APT 6E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1517
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2488 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-5203
Country	:	US
Telephone Number	:	646-283-2096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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