Healthcare Provider Details

I. General information

NPI: 1871926717
Provider Name (Legal Business Name): MRS. CHRISTINE JEAN GELINAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CHRISTINE JEAN COSTA

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 NORTH ST ATTN: CHILD AND FAMILY EMERGENCY SERVICES
NEW BEDFORD MA
02740-2782
US

IV. Provider business mailing address

543 NORTH ST ATTN: CHILD AND FAMILY EMERGENCY SERVICES
NEW BEDFORD MA
02740-2782
US

V. Phone/Fax

Practice location:
  • Phone: 508-996-3154
  • Fax: 508-991-8082
Mailing address:
  • Phone: 508-996-3154
  • Fax: 508-991-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number119286
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: