Provider Demographics
NPI:1619400256
Name:LIMONGELLO, CHRISTINE LAUREN (MA, EDS, NCSP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LAUREN
Last Name:LIMONGELLO
Suffix:
Gender:F
Credentials:MA, EDS, NCSP
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:LAUREN
Other - Last Name:DERISO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, EDS, NCSP
Mailing Address - Street 1:1 JENNIFER DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2368
Mailing Address - Country:US
Mailing Address - Phone:732-581-4443
Mailing Address - Fax:
Practice Address - Street 1:1 JENNIFER DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2368
Practice Address - Country:US
Practice Address - Phone:732-581-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ646827103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool