Provider Demographics
NPI:1528791985
Name:WASSEL, CHRISTINE HERNANDEZ (LMHC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:HERNANDEZ
Last Name:WASSEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8150 AVOSS LN
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8965
Mailing Address - Country:US
Mailing Address - Phone:315-640-1865
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST STE 1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2661
Practice Address - Country:US
Practice Address - Phone:315-671-2953
Practice Address - Fax:315-671-2954
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health