Provider Demographics
NPI:1285897942
Name:VARISCO, CHRISTOPHER R (MA)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:R
Last Name:VARISCO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 CALLE CALAF
Mailing Address - Street 2:PMB 266
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1314
Mailing Address - Country:US
Mailing Address - Phone:787-690-3224
Mailing Address - Fax:
Practice Address - Street 1:400 CALLE CALAF
Practice Address - Street 2:PMB 266
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1314
Practice Address - Country:US
Practice Address - Phone:787-690-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2919103TC1900X
PR0288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)