Healthcare Provider Details

I. General information

NPI: 1093140303
Provider Name (Legal Business Name): KRYSTAL NICOLE MACHADO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTAL NICOLE BARTLEY MA, CAGS, PSYD

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 GREENVILLE AVE UNIT E
JOHNSTON RI
02919-2656
US

IV. Provider business mailing address

269 GREENVILLE AVE UNIT E
JOHNSTON RI
02919-2656
US

V. Phone/Fax

Practice location:
  • Phone: 401-777-7924
  • Fax:
Mailing address:
  • Phone: 401-777-7924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS02170
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS02170
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPS02170
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS02170
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: