Provider Demographics
NPI:1407273501
Name:SORENSEN, CHRIS
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTIAN
Other - Middle Name:
Other - Last Name:SORENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1790 BROADWAY
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1412
Mailing Address - Country:US
Mailing Address - Phone:212-262-5348
Mailing Address - Fax:212-974-2944
Practice Address - Street 1:1790 BROADWAY
Practice Address - Street 2:SUITE 1501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1412
Practice Address - Country:US
Practice Address - Phone:212-262-5348
Practice Address - Fax:212-974-2944
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055587-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical