Provider Demographics
NPI:1144684739
Name:LABOULIERE, CHRISTA D (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:D
Last Name:LABOULIERE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:CHRISTA
Other - Middle Name:D
Other - Last Name:LABOULIERE-EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:275 CENTRAL PARK W APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3035
Mailing Address - Country:US
Mailing Address - Phone:917-960-7744
Mailing Address - Fax:
Practice Address - Street 1:275 CENTRAL PARK W APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3035
Practice Address - Country:US
Practice Address - Phone:917-960-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21453103TB0200X, 103TC0700X, 103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent