Provider Demographics
NPI:1437186426
Name:MAMCHUR, KRISTINE RENEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:RENEE
Last Name:MAMCHUR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5700
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5700
Mailing Address - Country:US
Mailing Address - Phone:866-431-4077
Mailing Address - Fax:413-774-7448
Practice Address - Street 1:31 HALL DR
Practice Address - Street 2:AMHERST MEDICAL CENTER
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2751
Practice Address - Country:US
Practice Address - Phone:413-256-4441
Practice Address - Fax:413-256-4412
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000877103TC0700X
MA9010103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical