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General NPI Number Information
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NPI Number | 1649210865
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Entity Type | Individual
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Provider Name | FREDRIC A KRISTAL PHD
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Gender | Male
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 29 FRANKLIN ST
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City | BANGOR
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State | ME
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Zip | 04401-4909
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Country | US
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Telephone | 207-942-3816
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Fax | 207-561-4725
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Provider Business Mailing Address
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Address Line | 29 FRANKLIN ST
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City | BANGOR
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State | ME
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Zip | 04401-4909
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Country | US
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Telephone | 207-942-3816
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Fax | 207-561-4725
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS925
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License Number State | ME
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