Provider Demographics
NPI:1235244682
Name:REARDON, CHRISTINE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:MARIE
Last Name:REARDON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 KROLL RD
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1608
Mailing Address - Country:US
Mailing Address - Phone:631-921-6314
Mailing Address - Fax:
Practice Address - Street 1:4190 SUNRISE HWY STE 1B
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5305
Practice Address - Country:US
Practice Address - Phone:631-921-6314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070866-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical