Healthcare Provider Details

I. General information

NPI: 1285325837
Provider Name (Legal Business Name): CRYSTAL MARIE BERARD-COTTER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ASYLUM ST
MILFORD MA
01757-2203
US

IV. Provider business mailing address

10 ASYLUM ST
MILFORD MA
01757-2203
US

V. Phone/Fax

Practice location:
  • Phone: 508-469-3110
  • Fax:
Mailing address:
  • Phone: 508-469-3110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: