Provider Demographics
NPI:1679575567
Name:CHRISTIANSEN, JOANN (MSW EDD)
Entity Type:Individual
Prefix:MS
First Name:JOANN
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:MSW EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2114
Mailing Address - Country:US
Mailing Address - Phone:413-586-6696
Mailing Address - Fax:413-587-8921
Practice Address - Street 1:135 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:NORTH HAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2114
Practice Address - Country:US
Practice Address - Phone:413-586-6696
Practice Address - Fax:413-587-8921
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL1CSW101357103T00000X
MAMAMFT462103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02456OtherBCBCS MA
0000164771OtherOPTUM
014053OtherHARVARD PILGRIM
321776OtherMHN
14184224OtherUBH
216466OtherMBC/BCBSMA
MA755714OtherTUFTS
P02456Medicare UPIN
0000164771OtherOPTUM