Provider Demographics
NPI:1386849131
Name:CHURCHILL, CHRISTIAN J JR (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:J
Last Name:CHURCHILL
Suffix:JR
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 LEXINGTON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0977
Mailing Address - Country:US
Mailing Address - Phone:646-316-3224
Mailing Address - Fax:
Practice Address - Street 1:16 E 41ST ST
Practice Address - Street 2:SUITE 3 A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6217
Practice Address - Country:US
Practice Address - Phone:646-316-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000856102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst