Provider Demographics
NPI:1366819948
Name:MESOPOTANESE, CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:MESOPOTANESE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MILLBURN AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1039
Mailing Address - Country:US
Mailing Address - Phone:732-648-3359
Mailing Address - Fax:
Practice Address - Street 1:28 MILLBURN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1039
Practice Address - Country:US
Practice Address - Phone:732-648-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-30
Last Update Date:2015-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100529000103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist