Provider Demographics
NPI:1841574084
Name:FIVES, CHRISTOPHER JUDE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JUDE
Last Name:FIVES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LONGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1450
Mailing Address - Country:US
Mailing Address - Phone:631-351-5334
Mailing Address - Fax:
Practice Address - Street 1:3 LONGVIEW CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-1450
Practice Address - Country:US
Practice Address - Phone:631-351-5334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016203103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist