Healthcare Provider Details

I. General information

NPI: 1740830728
Provider Name (Legal Business Name): CRYSTIMARIA KOTSIOPOULOS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CRYSTI KOTSIOPOULOS PSYD

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4238 WASHINGTON ST
ROSLINDALE MA
02131-2558
US

IV. Provider business mailing address

40 NOUVELLE WAY UNIT N848
NATICK MA
01760-6512
US

V. Phone/Fax

Practice location:
  • Phone: 781-790-4497
  • Fax: 781-622-9606
Mailing address:
  • Phone: 781-790-4497
  • Fax: 781-622-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY12726
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10000634
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: