MEDICARE: CHRISTENE LYNN MABB LMHC

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	101YM0800X	Mental Health Counselor	005392	NY

General Provider Information

NPI Number	:	1710226311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTENE LYNN MABB LMHC

Provider Business Mailing Address
First Line	:	3 LEAR JET LN STE 104N
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2322
Country	:	US
Telephone Number	:	518-560-4277
Fax Number	:	518-662-4277

Provider Business Practice Location Address
First Line	:	3 LEAR JET LN STE 104N
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2322
Country	:	US
Telephone Number	:	518-560-4277
Fax Number	:	518-662-4277

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

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	05/28/2026

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