Provider Demographics
NPI:1245657196
Name:DIVIAIO, CHRISTOPHER EDMUND I (LSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:EDMUND
Last Name:DIVIAIO
Suffix:I
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876
Mailing Address - Country:US
Mailing Address - Phone:908-707-0212
Mailing Address - Fax:908-707-8498
Practice Address - Street 1:285 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876
Practice Address - Country:US
Practice Address - Phone:908-707-0212
Practice Address - Fax:908-707-8498
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL058144001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical