Healthcare Provider Details

I. General information

NPI: 1245123561
Provider Name (Legal Business Name): CRISTINCI MATOS-TORRE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EATON ST
HAMPTON VA
23669-4054
US

IV. Provider business mailing address

2 EATON ST
HAMPTON VA
23669-4054
US

V. Phone/Fax

Practice location:
  • Phone: 757-838-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904018339
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: