Provider Demographics
NPI:1932663515
Name:DIRADO, KRISTINA PATRICIA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:PATRICIA
Last Name:DIRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048
Mailing Address - Country:US
Mailing Address - Phone:508-405-5620
Mailing Address - Fax:
Practice Address - Street 1:125 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1340
Practice Address - Country:US
Practice Address - Phone:508-405-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst