Basic Information
| Provider Information | |||||||||
| NPI: | 1700435245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WINGREN | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | BRIANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 87 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034478137 | ||||||||
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| Practice Location | |||||||||
| Address1: | 85 VERDUN ST | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035703364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037522689 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2019 | ||||||||
| LastUpdateDate: | 09/07/2019 | ||||||||
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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 | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.