Provider Demographics
NPI:1871818310
Name:OSTAN MAXWELL, CHRISTINA MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:MARIE
Last Name:OSTAN MAXWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MR
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MAXWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:20 SPRING GARDEN ST
Mailing Address - Street 2:UNIT 3
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-1227
Mailing Address - Country:US
Mailing Address - Phone:617-699-0028
Mailing Address - Fax:
Practice Address - Street 1:64 ELDREDGE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2017
Practice Address - Country:US
Practice Address - Phone:617-969-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-27
Last Update Date:2010-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health