Provider Demographics
NPI:1093144495
Name:ATHANASATOS, CHRISTINA
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:ATHANASATOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55A E RIDGEWOOD AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3884
Mailing Address - Country:US
Mailing Address - Phone:201-669-4911
Mailing Address - Fax:201-540-8104
Practice Address - Street 1:55A E RIDGEWOOD AVE STE 6
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3884
Practice Address - Country:US
Practice Address - Phone:201-669-4911
Practice Address - Fax:201-540-8104
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053359001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical