Healthcare Provider Details

I. General information

NPI: 1902633704
Provider Name (Legal Business Name): CRISTIN HALLORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 A N MAIN ST
SUNDERLAND MA
01375
US

IV. Provider business mailing address

296 HIGH ST
GREENFIELD MA
01301-2611
US

V. Phone/Fax

Practice location:
  • Phone: 413-665-8717
  • Fax: 413-665-9383
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: