Provider Demographics
NPI:1134512619
Name:SMITH, CHRISTINE (MA)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N CEDAR CREST BLVD STE 75
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2307
Mailing Address - Country:US
Mailing Address - Phone:484-519-1861
Mailing Address - Fax:
Practice Address - Street 1:1401 N CEDAR CREST BLVD STE 75
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2307
Practice Address - Country:US
Practice Address - Phone:484-519-1861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008604101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional