Provider Demographics
NPI:1386893576
Name:PETERS, CHRISTINE ANITA (LCSW, BCBA, LBA)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:ANITA
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSW, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NEPPERHAN ST APT 1110
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3836
Mailing Address - Country:US
Mailing Address - Phone:914-462-1926
Mailing Address - Fax:
Practice Address - Street 1:50 NEPPERHAN ST APT 1110
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3836
Practice Address - Country:US
Practice Address - Phone:914-462-1926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP65842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00801276Medicaid