Provider Demographics
NPI:1508247933
Name:SAMUELSEN, CHRISTINE (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:SAMUELSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:BRICKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2204 MARKET ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4649
Mailing Address - Country:US
Mailing Address - Phone:717-409-5414
Mailing Address - Fax:
Practice Address - Street 1:2204 MARKET ST STE 2
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4649
Practice Address - Country:US
Practice Address - Phone:717-409-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030708610001Medicaid