Provider Demographics
NPI:1407136880
Name:CHRISTOPHER, MARK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:CHRISTOPHER
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 1:31 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2509
Mailing Address - Country:US
Mailing Address - Phone:732-220-1998
Mailing Address - Fax:
Practice Address - Street 1:324 RARITAN AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2758
Practice Address - Country:US
Practice Address - Phone:732-572-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC003998001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical