Provider Demographics
NPI:1528195914
Name:TRENDELL, CHRISTINE N (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:N
Last Name:TRENDELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:N
Other - Last Name:MACCHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW013391041C0700X
MALICSW1213491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RICM32298Medicaid
30886-3OtherBLUE CROSS
407887OtherBLUE CHIP
62-37377OtherUNITED BEHAVIORAL HEALTH
007058343Medicare ID - Type Unspecified