Provider Demographics
NPI:1003441320
Name:GUNDERSON, CHRISTINE SIMONE (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SIMONE
Last Name:GUNDERSON
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:SIMONE
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL PSYCHOLOGIST
Mailing Address - Street 1:UNIT 3370 BOX 42
Mailing Address - Street 2:
Mailing Address - City:DPO
Mailing Address - State:AA
Mailing Address - Zip Code:34011-0042
Mailing Address - Country:US
Mailing Address - Phone:949-200-7115
Mailing Address - Fax:
Practice Address - Street 1:42 QUEEN STREET
Practice Address - Street 2:
Practice Address - City:NASSAU
Practice Address - State:NEW PROVIDENCE
Practice Address - Zip Code:00000
Practice Address - Country:BS
Practice Address - Phone:949-200-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160071453103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool