Provider Demographics
NPI:1932374212
Name:CARSON-SACCO, CHRISTINA IMO (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:IMO
Last Name:CARSON-SACCO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1509
Mailing Address - Country:US
Mailing Address - Phone:215-793-4151
Mailing Address - Fax:
Practice Address - Street 1:405 MADISON AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1509
Practice Address - Country:US
Practice Address - Phone:215-793-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016420103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical