Provider Demographics
NPI:1689049462
Name:MCPHERSON, CHRISTIANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIANA
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 VILLAGE DR APT 1008B
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-8296
Mailing Address - Country:US
Mailing Address - Phone:631-902-1677
Mailing Address - Fax:
Practice Address - Street 1:1008 VILLAGE DR APT 1008B
Practice Address - Street 2:
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-8296
Practice Address - Country:US
Practice Address - Phone:631-902-1677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-05
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092979101Y00000X
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13664139OtherCAQH