Provider Demographics
NPI:1942413570
Name:SEMMELMEYER, KRISTIN L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:SEMMELMEYER
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 1:40 SACRAMENTO STREET
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-354-4884
Mailing Address - Fax:617-864-0538
Practice Address - Street 1:40 SACRAMENTO STREET
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-354-4884
Practice Address - Fax:617-864-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7840103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0501671Medicaid
MAW05997OtherBLUE CROSS BLUE SHIELD
MA411859OtherTUFTS
MAW50901Medicare ID - Type Unspecified