Provider Demographics
NPI:1861872418
Name:WALTERS, CHRISTINA (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2900
Mailing Address - Country:US
Mailing Address - Phone:215-219-7342
Mailing Address - Fax:
Practice Address - Street 1:504 ALDRICH RD
Practice Address - Street 2:STE 2C
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1939
Practice Address - Country:US
Practice Address - Phone:848-231-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100548200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical