Provider Demographics
NPI:1073629895
Name:VANKLEECK, CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:VANKLEECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HEATHER CIR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:MA
Mailing Address - Zip Code:01522-1419
Mailing Address - Country:US
Mailing Address - Phone:508-612-6212
Mailing Address - Fax:508-210-0553
Practice Address - Street 1:255 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1976
Practice Address - Country:US
Practice Address - Phone:508-612-6212
Practice Address - Fax:508-210-0553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110023655AMedicaid
MA680014015OtherRRMCR
MA0521477Medicaid
MAW04406OtherBLUECROSS