=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346363603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL CRYSTAL ED.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 173 MOUNT AUBURN ST
-----------------------------------------------------
City | WATERTOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02472-4005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-928-0848
-----------------------------------------------------
Fax | 617-928-0860
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 HIGHLAND TER
-----------------------------------------------------
City | NEWTONVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02460-1813
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-928-0848
-----------------------------------------------------
Fax | 617-928-0860
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC1900X
-----------------------------------------------------
Taxonomy Name | Counseling Psychologist
-----------------------------------------------------
License Number | 6692
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------