Provider Demographics
NPI:1275148637
Name:MACNAUGHTON, CHRISTINE LESLIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LESLIE
Last Name:MACNAUGHTON
Suffix:
Gender:F
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:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-0255
Mailing Address - Country:US
Mailing Address - Phone:845-625-7636
Mailing Address - Fax:
Practice Address - Street 1:1 LAKE RD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-3705
Practice Address - Country:US
Practice Address - Phone:845-625-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-12
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty