Provider Demographics
NPI:1639720303
Name:LOVEGOOD, CHRISTINE NICOLE
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:NICOLE
Last Name:LOVEGOOD
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 1:4076 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1724
Mailing Address - Country:US
Mailing Address - Phone:508-395-0413
Mailing Address - Fax:
Practice Address - Street 1:4076 WASHINGTON ST APT 3
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1724
Practice Address - Country:US
Practice Address - Phone:508-395-0413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst