Healthcare Provider Details

I. General information

NPI: 1184904112
Provider Name (Legal Business Name): CHRISTOPHER WALLACE KREBS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SPRINGS RD 116B
BEDFORD MA
01730-1114
US

IV. Provider business mailing address

200 SPRINGS RD 116B
BEDFORD MA
01730-1114
US

V. Phone/Fax

Practice location:
  • Phone: 781-687-2641
  • Fax: 781-687-3044
Mailing address:
  • Phone: 781-687-2641
  • Fax: 781-687-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9397
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: