Provider Demographics
NPI:1376203869
Name:SOTO, CRYSTAL (LICSW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:SOTO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TUSCAN BLVD UNIT 553
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-5415
Mailing Address - Country:US
Mailing Address - Phone:857-225-3469
Mailing Address - Fax:
Practice Address - Street 1:250 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1982
Practice Address - Country:US
Practice Address - Phone:857-225-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-23
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 251S00000X
MALICSW1268241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health