Provider Demographics
NPI:1023184066
Name:SOWLEY, CHRISTOPHER A (CP)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:SOWLEY
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 HENRY HUDSON PKWY
Mailing Address - Street 2:APT 801
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3836
Mailing Address - Country:US
Mailing Address - Phone:718-543-3714
Mailing Address - Fax:718-543-3714
Practice Address - Street 1:23 OLD MAMARONECK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2061
Practice Address - Country:US
Practice Address - Phone:914-761-2933
Practice Address - Fax:914-761-3034
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009041103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01592938Medicaid
NYV01141Medicare PIN
NYV0114V0221Medicare PIN