Provider Demographics
NPI:1578295341
Name:CARTER, CHRISTOPHER JEROME (PHD, LP)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:JEROME
Last Name:CARTER
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:DR
Other - First Name:CHRISTOPHER
Other - Middle Name:J
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:2572 WALLACE AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8811
Mailing Address - Country:US
Mailing Address - Phone:347-727-3564
Mailing Address - Fax:
Practice Address - Street 1:2572 WALLACE AVE APT 4D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8811
Practice Address - Country:US
Practice Address - Phone:347-727-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001117-01102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst