Provider Demographics
NPI:1003283664
Name:CONFORTO, CHRISTINA MARIA (LSW, MED)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIA
Last Name:CONFORTO
Suffix:
Gender:F
Credentials:LSW, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 YALE ST
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6029
Mailing Address - Country:US
Mailing Address - Phone:781-424-1692
Mailing Address - Fax:
Practice Address - Street 1:9 YALE ST
Practice Address - Street 2:APARTMENT 1
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6029
Practice Address - Country:US
Practice Address - Phone:781-424-1692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA313718104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker