Provider Demographics
NPI:1699381491
Name:GARCIA DERAS, KRYSTAL ELIZABETH (R-DMT)
Entity Type:Individual
Prefix:MISS
First Name:KRYSTAL
Middle Name:ELIZABETH
Last Name:GARCIA DERAS
Suffix:
Gender:F
Credentials:R-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHESTER AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-3232
Mailing Address - Country:US
Mailing Address - Phone:617-610-5103
Mailing Address - Fax:
Practice Address - Street 1:70 EVERETT AVE STE 515
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2363
Practice Address - Country:US
Practice Address - Phone:617-466-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health