Provider Demographics
NPI:1891264511
Name:CRISTOL, SAMANTHA ELYSSA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ELYSSA
Last Name:CRISTOL
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BROWN STREET
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:516-761-0114
Mailing Address - Fax:
Practice Address - Street 1:15 HOMER AVENUE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:516-761-0114
Practice Address - Fax:617-441-4092
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11956103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist