Provider Demographics
NPI:1710462197
Name:DOE, CHRISTINA S
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:S
Last Name:DOE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:S
Other - Last Name:BAGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-2544
Mailing Address - Country:US
Mailing Address - Phone:413-772-1380
Mailing Address - Fax:413-772-1319
Practice Address - Street 1:125 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2544
Practice Address - Country:US
Practice Address - Phone:413-772-1380
Practice Address - Fax:413-772-1319
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119227104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker