Basic Information
| Provider Information | |||||||||
| NPI: | 1144303462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RHEINWALD | ||||||||
| FirstName: | KRYSTAL | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024535356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818948440 | ||||||||
| FaxNumber: | 7818941202 | ||||||||
| Practice Location | |||||||||
| Address1: | 169 ELM ST | ||||||||
| Address2: | |||||||||
| City: | WALTHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024535356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818948440 | ||||||||
| FaxNumber: | 7818941202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 110557 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1303287 | 01 | MA | MBHP | OTHER | 99618201 | 01 | NETWORK HEALTH | OTHER | M18633 | 01 | MA | BCBS | OTHER | 703136 | 01 | TUFTS | OTHER | NP01332 | 01 | BOSTON MED CTR | OTHER | P10329 | 01 | MA | BCBS | OTHER | 1004745 | 01 | NHP | OTHER | 1303287 | 05 | MA | MEDICAID |