Provider Demographics
NPI:1215924014
Name:CARSTENS, CHRISTOPHER GERALD (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GERALD
Last Name:CARSTENS
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 1:9255 TOWNE CENTRE DR
Mailing Address - Street 2:SUITE 875
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3033
Mailing Address - Country:US
Mailing Address - Phone:858-455-5252
Mailing Address - Fax:858-455-5556
Practice Address - Street 1:9255 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 875
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3033
Practice Address - Country:US
Practice Address - Phone:858-455-5252
Practice Address - Fax:858-455-5556
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5654103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 5654OtherLICENSE
CAPSY 5654OtherLICENSE