Provider Demographics
NPI:1558467449
Name:FEWELL, CHRISTINE H (PHD, LCSW, CASAC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:H
Last Name:FEWELL
Suffix:
Gender:F
Credentials:PHD, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 NICHOLS DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3525
Mailing Address - Country:US
Mailing Address - Phone:914-478-2040
Mailing Address - Fax:
Practice Address - Street 1:4 NICHOLS DR
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-3525
Practice Address - Country:US
Practice Address - Phone:914-478-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR012623-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN10322Medicare ID - Type Unspecified4 NICHOLS DR, H-ON-H, NY