Basic Information
| Provider Information | |||||||||
| NPI: | 1710334792 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CHRISTINA | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MECHANIC ST | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016082420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087925400 | ||||||||
| FaxNumber: | 5088310074 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PLAISTOW RD | ||||||||
| Address2: | |||||||||
| City: | HAVERHILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018301419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783734985 | ||||||||
| FaxNumber: | 5088310074 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2016 | ||||||||
| LastUpdateDate: | 05/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | Y10400 | 01 | MA | GROUP MEDICARE # | OTHER |