Provider Demographics
NPI:1790752517
Name:SAFFO, CRISTIN MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:MARIE
Last Name:SAFFO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2971 CROUSE LN STE A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8446
Mailing Address - Country:US
Mailing Address - Phone:336-524-1628
Mailing Address - Fax:
Practice Address - Street 1:2971 CROUSE LN STE A
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-524-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7380103T00000X
NC4732103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ49610E485OtherMEDICARE