Provider Demographics
NPI:1578789012
Name:MACHLICA, CHRISTINE MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:MARY
Last Name:MACHLICA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:MARY
Other - Last Name:FROEHLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43 ASHLAND DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-366-0469
Mailing Address - Fax:631-543-8573
Practice Address - Street 1:66 HAVRID RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:516-313-3397
Practice Address - Fax:516-543-8573
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0500301104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2579650OtherOXFORD
NYP2579650OtherOXFORD