Provider Demographics
NPI:1871631325
Name:HARTER, KRISTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:HARTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5658
Mailing Address - Country:US
Mailing Address - Phone:617-817-5237
Mailing Address - Fax:
Practice Address - Street 1:1696 MASSACHUSETTS AVE FL 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1803
Practice Address - Country:US
Practice Address - Phone:617-817-5237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical