Provider Demographics
NPI:1225238751
Name:CONCILLION, CHRISTIAN
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:
Last Name:CONCILLION
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:CONCILLION
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS MFT
Mailing Address - Street 1:930 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1629
Mailing Address - Country:US
Mailing Address - Phone:914-381-6110
Mailing Address - Fax:914-381-6964
Practice Address - Street 1:930 MAMARONECK AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1629
Practice Address - Country:US
Practice Address - Phone:914-381-6110
Practice Address - Fax:914-381-6964
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP57457106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist