Basic Information
| Provider Information | |||||||||
| NPI: | 1427380690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRAY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | LYN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 177 WOODSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | WINTHROP | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021522061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178180132 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14 PORTER ST | ||||||||
| Address2: | |||||||||
| City: | EAST BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021282116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6175693189 | ||||||||
| FaxNumber: | 6175697890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2010 | ||||||||
| LastUpdateDate: | 02/12/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.