Healthcare Provider Details

I. General information

NPI: 1548306798
Provider Name (Legal Business Name): CHRISTOPHER PSAROPULOS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE ST
GARDNER MA
01440-3876
US

IV. Provider business mailing address

55 LAKE ST
GARDNER MA
01440-3876
US

V. Phone/Fax

Practice location:
  • Phone: 508-849-5648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5624
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: