Provider Demographics
NPI:1669668638
Name:CRIST, KASEY PAULA (MED)
Entity Type:Individual
Prefix:MS
First Name:KASEY
Middle Name:PAULA
Last Name:CRIST
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GENERAL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1809
Mailing Address - Country:US
Mailing Address - Phone:978-620-1709
Mailing Address - Fax:978-683-6074
Practice Address - Street 1:30 GENERAL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1809
Practice Address - Country:US
Practice Address - Phone:978-620-1709
Practice Address - Fax:978-683-6074
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health