Provider Demographics
NPI:1366983330
Name:ELLER, CHRISTINA (LMHC MSED)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:LMHC MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S END AVE
Mailing Address - Street 2:APT 2N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1026
Mailing Address - Country:US
Mailing Address - Phone:917-743-3575
Mailing Address - Fax:
Practice Address - Street 1:395 S END AVE
Practice Address - Street 2:APT 2N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1026
Practice Address - Country:US
Practice Address - Phone:917-743-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP02671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health