Provider Demographics
NPI:1164727558
Name:NEEDHAM, CHRISTINE MARIE (EDD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:NEEDHAM
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17597 ROCKEFELLER CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-5802
Mailing Address - Country:US
Mailing Address - Phone:239-267-0887
Mailing Address - Fax:239-267-0823
Practice Address - Street 1:17597 ROCKEFELLER CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33967-5802
Practice Address - Country:US
Practice Address - Phone:239-267-0887
Practice Address - Fax:239-267-0823
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS0000297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist