Provider Demographics
NPI:1003226713
Name:SHOCKLEY, KRISTY (MA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 W MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-1421
Mailing Address - Country:US
Mailing Address - Phone:978-866-3874
Mailing Address - Fax:
Practice Address - Street 1:96 W MEADOW RD
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-1421
Practice Address - Country:US
Practice Address - Phone:978-866-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service