Provider Demographics
NPI:1790752517
Name:SAFFO, CRISTIN MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRISTIN
Middle Name:MARIE
Last Name:SAFFO
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 1:4400 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:STE A #108
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6760
Mailing Address - Country:US
Mailing Address - Phone:336-524-1628
Mailing Address - Fax:336-792-5896
Practice Address - Street 1:100 HABERSHAM DR
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5116
Practice Address - Country:US
Practice Address - Phone:336-524-1628
Practice Address - Fax:336-792-5896
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7380103T00000X
NC4732103T00000X
LA1646103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ49610E485OtherMEDICARE