Provider Demographics
NPI:1003193699
Name:HALE, CHRISTOPHER H (EDD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:HALE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1340
Mailing Address - Country:US
Mailing Address - Phone:860-960-9149
Mailing Address - Fax:
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1818
Practice Address - Country:US
Practice Address - Phone:860-527-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2387101YP2500X
104100000X
CT0101211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010121OtherLICENSED CLINICAL SOCIAL WORKER