Provider Demographics
NPI:1780782995
Name:NEVINS, CHRISTINE KATHLEEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:KATHLEEN
Last Name:NEVINS
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 1:37 STONEBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-3024
Mailing Address - Country:US
Mailing Address - Phone:508-653-6433
Mailing Address - Fax:
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1115
Practice Address - Country:US
Practice Address - Phone:508-650-1802
Practice Address - Fax:508-650-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4521OtherPSYCHOLOGIST LICENSE #
MA03000509OtherHEALTH CARE PROVIDER #
MA4521OtherPSYCHOLOGIST LICENSE #