Provider Demographics
NPI:1669519336
Name:DI NARDO-DUPRE, CRISTINA (LICSW)
Entity type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:DI NARDO-DUPRE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1647
Mailing Address - Country:US
Mailing Address - Phone:413-789-9198
Mailing Address - Fax:
Practice Address - Street 1:169 COUNTRY RD
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1647
Practice Address - Country:US
Practice Address - Phone:413-789-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA791017OtherTUFTS PROVIDER NUMBER
MAP04545OtherBC BS PROVIDER NUMBER
MA791017OtherTUFTS PROVIDER NUMBER