Provider Demographics
NPI:1093338451
Name:VINCK, KRIZIA AMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRIZIA
Middle Name:AMY
Last Name:VINCK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KRIZIA
Other - Middle Name:AMY
Other - Last Name:CRESPO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:559 FOUNDRY ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1357
Mailing Address - Country:US
Mailing Address - Phone:617-895-8279
Mailing Address - Fax:
Practice Address - Street 1:559 FOUNDRY ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1357
Practice Address - Country:US
Practice Address - Phone:617-895-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10553103G00000X
MAPY11174103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist