Provider Demographics
NPI:1801868732
Name:MUSELLO, CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:MUSELLO
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DOVER CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23430-6145
Mailing Address - Country:US
Mailing Address - Phone:781-718-5515
Mailing Address - Fax:978-268-5088
Practice Address - Street 1:100 DOVER CT
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:VA
Practice Address - Zip Code:23430-6145
Practice Address - Country:US
Practice Address - Phone:781-718-5515
Practice Address - Fax:978-268-5088
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-04
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30018051240001Medicaid
MA0525751Medicaid