Provider Demographics
NPI:1124992359
Name:PARKER, CHRISTIE (LEP)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FOX RUN LN
Mailing Address - Street 2:
Mailing Address - City:EAST FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-4028
Mailing Address - Country:US
Mailing Address - Phone:315-591-3694
Mailing Address - Fax:
Practice Address - Street 1:105 FOX RUN LN
Practice Address - Street 2:
Practice Address - City:EAST FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02536-4028
Practice Address - Country:US
Practice Address - Phone:315-591-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1239103T00000X
MA477834103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist