Healthcare Provider Details

I. General information

NPI: 1780175083
Provider Name (Legal Business Name): KRISTA LAWRENCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 GROVE ST
CHICOPEE MA
01020-1820
US

IV. Provider business mailing address

82 ARDMORE ST
SPRINGFIELD MA
01104-2233
US

V. Phone/Fax

Practice location:
  • Phone: 413-330-7774
  • Fax: 508-433-1871
Mailing address:
  • Phone: 413-693-9290
  • Fax: 508-433-1871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT10000090
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: