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NPI Code Detail

MEDICARE: CHRYSTAL BROGNA LMHC

MEDICARE: CHRYSTAL BROGNA LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1376022657
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRYSTAL BROGNA LMHC
Provider Business Mailing Address
First Line : 55 LAKE ST STE 240
Second Line :
City : GARDNER
State : MA
Zip : 01440-3876
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 55 LAKE ST STE 240
Second Line :
City : GARDNER
State : MA
Zip : 01440-3876
Country : US
Telephone Number : 978-855-3129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2018
Last Update Date : 02/04/2026

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Directions to “ CHRYSTAL BROGNA LMHC” Practice Location

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