Provider Demographics
NPI:1477038958
Name:VENDETTI, CHRISTINA LOUISE (LMSW, LICSW, LCSW,)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:VENDETTI
Suffix:
Gender:F
Credentials:LMSW, LICSW, LCSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3611
Mailing Address - Country:US
Mailing Address - Phone:914-539-5613
Mailing Address - Fax:
Practice Address - Street 1:7 WARREN ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3611
Practice Address - Country:US
Practice Address - Phone:914-539-5613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081146-1104100000X
PASW133993104100000X
MA117479-SW-LICSW1041C0700X
DCLC500813191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY081146-1OtherNYS OFFICE OF THE PROFESSIONS
MA117479-SW-LICSWOtherCOMMONWEALTH OF MASSACHUSETTS
DCLC50081319OtherDISTRICT OF COLUMBIA DOH
PASW133993OtherCOMMONWEALTH OF PENNSYLVANIA