Healthcare Provider Details

I. General information

NPI: 1801868732
Provider Name (Legal Business Name): CHRISTINE MUSELLO PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DOVER CT
SMITHFIELD VA
23430-6145
US

IV. Provider business mailing address

100 DOVER CT
SMITHFIELD VA
23430-6145
US

V. Phone/Fax

Practice location:
  • Phone: 781-718-5515
  • Fax: 978-268-5088
Mailing address:
  • Phone: 781-718-5515
  • Fax: 978-268-5088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6788
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: