Provider Demographics
NPI:1497006076
Name:LAJUDICE, CHRISTIANA MARIE (MS/CAS)
Entity Type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:MARIE
Last Name:LAJUDICE
Suffix:
Gender:F
Credentials:MS/CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 THORNCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1208
Mailing Address - Country:US
Mailing Address - Phone:716-984-7156
Mailing Address - Fax:
Practice Address - Street 1:12 MOHAWK ST
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-1028
Practice Address - Country:US
Practice Address - Phone:518-359-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY650057121103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool