Provider Demographics
NPI:1063784569
Name:WEIDENHAMER, CHRISTIE ELIZABETH (LMHC)
Entity type:Individual
Prefix:MS
First Name:CHRISTIE
Middle Name:ELIZABETH
Last Name:WEIDENHAMER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:CHRISTIE
Other - Middle Name:ELIZABETH
Other - Last Name:CAMIOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:58 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2301
Mailing Address - Country:US
Mailing Address - Phone:585-406-2684
Mailing Address - Fax:585-413-0640
Practice Address - Street 1:58 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2301
Practice Address - Country:US
Practice Address - Phone:585-406-2684
Practice Address - Fax:585-413-0640
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18 004249101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health