Provider Demographics
NPI:1841803061
Name:MAVRIDIS, CHRISTIE LISA (LIMITED PERMIT LMSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:LISA
Last Name:MAVRIDIS
Suffix:
Gender:F
Credentials:LIMITED PERMIT LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 TITUSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2944
Mailing Address - Country:US
Mailing Address - Phone:914-450-9474
Mailing Address - Fax:
Practice Address - Street 1:316 TITUSVILLE RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2944
Practice Address - Country:US
Practice Address - Phone:914-450-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP105258104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker