Provider Demographics
NPI:1225511199
Name:CHRISTENSEN, THOMAS GEORGE (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GEORGE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 COLUMBUS AVE APT 21C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5169
Mailing Address - Country:US
Mailing Address - Phone:571-236-1187
Mailing Address - Fax:
Practice Address - Street 1:808 COLUMBUS AVE APT 21C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5169
Practice Address - Country:US
Practice Address - Phone:571-236-1187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0960341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP13168Medicaid