1568640704 NPI number — DR. M. CRISTINA SORRENTINO SCHMALISCH PHD MSW

Table of content: DR. M. CRISTINA SORRENTINO SCHMALISCH PHD MSW (NPI 1568640704)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568640704 NPI number — DR. M. CRISTINA SORRENTINO SCHMALISCH PHD MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHMALISCH
Provider First Name:
M. CRISTINA
Provider Middle Name:
SORRENTINO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SORRENTINO
Provider Other First Name:
CRISTINA
Provider Other Middle Name:
M.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568640704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 VIRGINIA ST
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
SOMERVILLE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02145-3910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-899-6841
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 CONCORD AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02138-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-899-6841
Provider Business Practice Location Address Fax Number:
617-876-9011
Provider Enumeration Date:
02/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  115000 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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