Healthcare Provider Details

I. General information

NPI: 1790752517
Provider Name (Legal Business Name): CRISTIN MARIE SAFFO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/23/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HABERSHAM DR
YOUNGSVILLE LA
70592-5116
US

IV. Provider business mailing address

4400 AMBASSADOR CAFFERY PKWY STE A #108
LAFAYETTE LA
70508-6760
US

V. Phone/Fax

Practice location:
  • Phone: 336-524-1628
  • Fax: 336-792-5896
Mailing address:
  • Phone: 336-524-1628
  • Fax: 336-792-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7380
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4732
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1646
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: