Provider Demographics
NPI:1831709310
Name:TYLER, CHRISTOPHER L (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:L
Last Name:TYLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SHOKAN
Mailing Address - State:NY
Mailing Address - Zip Code:12481-5307
Mailing Address - Country:US
Mailing Address - Phone:215-341-9516
Mailing Address - Fax:
Practice Address - Street 1:18 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SHOKAN
Practice Address - State:NY
Practice Address - Zip Code:12481-5307
Practice Address - Country:US
Practice Address - Phone:215-341-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-09
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097860104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker