Provider Demographics
NPI:1750877924
Name:CARLINO, CHRISTOPHER ROBERT
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:CARLINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 TURNER AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6314
Mailing Address - Country:US
Mailing Address - Phone:203-545-8453
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE # 307B
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-376-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty