1609824820 NPI number — MS. CHRISTINE L BAVARO MED LMHC

Table of content: MS. CHRISTINE L BAVARO MED LMHC (NPI 1609824820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609824820 NPI number — MS. CHRISTINE L BAVARO MED LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAVARO
Provider First Name:
CHRISTINE
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MED LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609824820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55-14 ASH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-774-7975
Provider Business Mailing Address Fax Number:
978-774-3360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 KIMBALL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNNFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01940-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-246-2315
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2006

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: 101YM0800X , with the licence number:  3855 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 200200 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 142082XX . This is a "PREFERRED CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3855 . This is a "LMHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200200 . This is a "LCSW" identifier . This identifiers is of the category "OTHER".
  • Identifier: ROLM0015 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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