Provider Demographics
NPI:1881315208
Name:SINGH, KRYSTAL AMBER
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:AMBER
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:AMBER
Other - Last Name:KENNETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 STONE LN APT 2117
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-1559
Mailing Address - Country:US
Mailing Address - Phone:678-643-0918
Mailing Address - Fax:
Practice Address - Street 1:555 AMORY ST STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2672
Practice Address - Country:US
Practice Address - Phone:857-399-1905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAWYR11618368WOtherPRIVATE INSURER