Provider Demographics
NPI:1154474047
Name:CHRISTIANSEN, NORMAN HENRIK (EDD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:HENRIK
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-2022
Mailing Address - Country:US
Mailing Address - Phone:413-527-8308
Mailing Address - Fax:413-585-0280
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-2022
Practice Address - Country:US
Practice Address - Phone:413-527-8308
Practice Address - Fax:413-585-0280
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA380322OtherMAGELLAN HEALTH CARE
MAWO4822Medicaid
MAWO4822Medicare ID - Type Unspecified