Provider Demographics
NPI:1265318000
Name:PETRICK, CHRISTINE (LAC, NCC, ATR-P)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:PETRICK
Suffix:
Gender:F
Credentials:LAC, NCC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HEYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-3017
Mailing Address - Country:US
Mailing Address - Phone:607-624-9367
Mailing Address - Fax:
Practice Address - Street 1:47 MILLER ST.
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114
Practice Address - Country:US
Practice Address - Phone:973-639-6574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-15
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00891000106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist