Provider Demographics
NPI:1336615863
Name:MCDONOUGH, CHRISTOPHER STEPHEN (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:STEPHEN
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PONDFIELD RD STE 312
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3818
Mailing Address - Country:US
Mailing Address - Phone:914-625-7447
Mailing Address - Fax:
Practice Address - Street 1:280 DOBBS FERRY RD STE 306
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1908
Practice Address - Country:US
Practice Address - Phone:914-625-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000147103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-00-0153OtherBOARD CERTIFIED BEHAVIOR ANALYST