Healthcare Provider Details

I. General information

NPI: 1538292065
Provider Name (Legal Business Name): CRYSTAL CHRISTOPHERSEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SWAN LAKE AVE
MONROE ME
04951-3719
US

IV. Provider business mailing address

68 MAIN ST SUITE #3
ANDOVER MA
01810-3846
US

V. Phone/Fax

Practice location:
  • Phone: 207-962-2816
  • Fax:
Mailing address:
  • Phone: 617-600-7456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6216
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5109
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: