Provider Demographics
NPI:1013672112
Name:BOARDMAN, CHRISTINA MARY (LMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARY
Last Name:BOARDMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:577 PROSPECT AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-6073
Mailing Address - Country:US
Mailing Address - Phone:917-297-4698
Mailing Address - Fax:718-387-6024
Practice Address - Street 1:577 PROSPECT AVE APT 3A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6073
Practice Address - Country:US
Practice Address - Phone:917-297-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003219101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health