Provider Demographics
NPI:1093140303
Name:MACHADO, KRYSTAL NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRYSTAL
Middle Name:NICOLE
Last Name:MACHADO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:NICOLE
Other - Last Name:BARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CAGS, PSYD
Mailing Address - Street 1:359 PUTNAM PIKE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2709
Mailing Address - Country:US
Mailing Address - Phone:401-777-7924
Mailing Address - Fax:
Practice Address - Street 1:359 PUTNAM PIKE UNIT 104
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2709
Practice Address - Country:US
Practice Address - Phone:401-777-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS02170103T00000X, 103TC1900X, 103TM1800X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities