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General NPI Number Information
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NPI Number | 1891264511
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Entity Type | Individual
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Provider Name | SAMANTHA ELYSSA CRISTOL PSY D
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 15 HOMER AVENUE
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City | CAMBRIDGE
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State | MA
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Zip | 02138
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Country | US
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Telephone | 516-761-0114
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Fax | 617-441-4092
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Provider Business Mailing Address
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Address Line | 87 BROWN STREET APARTMENT 3
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City | WALTHAM
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State | MA
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Zip | 02453
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Country | US
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Telephone | 516-761-0114
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11956
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License Number State | MA
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