Provider Demographics
NPI:1346363603
Name:CRYSTAL, RACHEL (EDD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:CRYSTAL
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HIGHLAND TER
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1813
Mailing Address - Country:US
Mailing Address - Phone:617-928-0848
Mailing Address - Fax:617-928-0860
Practice Address - Street 1:173 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4005
Practice Address - Country:US
Practice Address - Phone:617-928-0848
Practice Address - Fax:617-928-0860
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6692103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA010229OtherHP
MA767925OtherTUFTS HEALTH PLAN
MA162374OtherVALUE OPTIONS
MAW05412OtherBLUE CROSS
MA6279191OtherUBH
MAW50001Medicare ID - Type UnspecifiedMEDICARE NUMBER