Provider Demographics
NPI:1861062184
Name:BRUNDAGE, CHRISTOPHER LYNN (LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:LYNN
Last Name:BRUNDAGE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 KINDERKAMACK RD STE M
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1344
Mailing Address - Country:US
Mailing Address - Phone:856-543-9364
Mailing Address - Fax:856-543-9365
Practice Address - Street 1:141 KINDERKAMACK RD STE M
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1344
Practice Address - Country:US
Practice Address - Phone:856-543-9364
Practice Address - Fax:856-543-9365
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00772500103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling