Provider Demographics
NPI:1760833578
Name:DEMAREST, CHRISTIE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:A
Last Name:DEMAREST
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 1:450 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1535
Mailing Address - Country:US
Mailing Address - Phone:201-394-2961
Mailing Address - Fax:
Practice Address - Street 1:450 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:NJ
Practice Address - Zip Code:07628-1535
Practice Address - Country:US
Practice Address - Phone:201-394-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051717001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical