Individual
CHRISTINA THEODORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
8268 164TH ST, JAMAICA, NY 11432-1121
(718) 883-2887
Mailing address
8268 164TH ST, JAMAICA, NY 11432-1121
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
096328
NY
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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