Provider Demographics
NPI:1083683338
Name:CHRISTENSEN, CARL WILLIAM (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:WILLIAM
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ALEXANDER ST.
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607
Mailing Address - Country:US
Mailing Address - Phone:585-262-4303
Mailing Address - Fax:585-262-4363
Practice Address - Street 1:277 ALEXANDER ST.
Practice Address - Street 2:SUITE 306
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607
Practice Address - Country:US
Practice Address - Phone:585-262-4303
Practice Address - Fax:585-262-4363
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO36366-11041C0700X
NYPENDING106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103235FKOtherPREFERRED CARE
NY010036366OtherBLUE CHOICE - EXCELLUS
NY01410746Medicaid