Provider Demographics
NPI:1467891465
Name:GOPICHAND, KRYSTAL-ANN
Entity Type:Individual
Prefix:
First Name:KRYSTAL-ANN
Middle Name:
Last Name:GOPICHAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E 53RD ST APT 7X
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2345
Mailing Address - Country:US
Mailing Address - Phone:914-721-8564
Mailing Address - Fax:
Practice Address - Street 1:1200 E 53RD ST APT 7X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2345
Practice Address - Country:US
Practice Address - Phone:914-721-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00244220Medicaid