Provider Demographics
NPI:1992847529
Name:KRISTAL, JANE LOIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:LOIS
Last Name:KRISTAL
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 1:33 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002
Mailing Address - Country:US
Mailing Address - Phone:413-549-4544
Mailing Address - Fax:802-228-4604
Practice Address - Street 1:33 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002
Practice Address - Country:US
Practice Address - Phone:413-549-4544
Practice Address - Fax:802-228-4604
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA062966000OtherMAGELLAN
MAW02428OtherBLUE SHIELD
W02428Medicare ID - Type Unspecified
MAW02428OtherBLUE SHIELD