Provider Demographics
NPI:1740429539
Name:JENNINGS, CHRISTOPHER TYRONE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TYRONE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FEDERAL ST
Mailing Address - Street 2:SUITE 227
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1061
Mailing Address - Country:US
Mailing Address - Phone:866-984-2665
Mailing Address - Fax:866-634-2131
Practice Address - Street 1:200 FEDERAL ST
Practice Address - Street 2:SUITE 227
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1061
Practice Address - Country:US
Practice Address - Phone:866-984-2665
Practice Address - Fax:866-634-2131
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 101YP2500X, 103K00000X, 103TH0004X, 103TP2701X
DEF23822101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy