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General NPI Number Information
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NPI Number | 1659876746
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Entity Type | Individual
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Provider Name | CRIS CARL LADC1
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Gender | Female
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 1 ARCH PL STE 3
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City | GREENFIELD
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State | MA
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Zip | 01301-2457
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Country | US
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Telephone | 413-341-1892
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Fax | 413-774-4312
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Provider Business Mailing Address
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Address Line | 43A GROVE ST
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City | GREENFIELD
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State | MA
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Zip | 01301-2327
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Country | US
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Telephone | 413-475-2855
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15983
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License Number State | MA
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