Provider Demographics
NPI:1124145503
Name:ANDERSON, CHRISTOPHER MARC (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MARC
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 CABOT STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-232-0192
Mailing Address - Fax:781-944-6535
Practice Address - Street 1:234 CABOT STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-232-0192
Practice Address - Fax:781-944-6535
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA7791103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent