Provider Demographics
NPI:1205876398
Name:NEZU, CHRISTINE M (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:M
Last Name:NEZU
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1505 RACE ST
Mailing Address - Street 2:ROOM 306 A PSYCHOLOGY
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1119
Mailing Address - Country:US
Mailing Address - Phone:215-762-3677
Mailing Address - Fax:215-762-8683
Practice Address - Street 1:1505 RACE ST
Practice Address - Street 2:ROOM 306 A PSYCHOLOGY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1119
Practice Address - Country:US
Practice Address - Phone:215-762-3677
Practice Address - Fax:215-762-8683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS-006015-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical