Provider Demographics
NPI:1124189105
Name:KRELL, FREDERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:
Last Name:KRELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SALEM GRN
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3724
Mailing Address - Country:US
Mailing Address - Phone:978-740-3100
Mailing Address - Fax:978-740-3100
Practice Address - Street 1:1 SALEM GRN
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3724
Practice Address - Country:US
Practice Address - Phone:978-740-3100
Practice Address - Fax:978-740-3100
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA762103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA104133OtherMERIT BEHAVIORAL
MA95907OtherMHN
MAIP098621OtherMAGELLAN
MAW10327OtherBLUE CROSS GROUP NUMBER
MAKRW01832OtherBLUE CROSS INDIVIDUAL NUM
MAW10327Medicare ID - Type Unspecified