Provider Demographics
NPI:1619100849
Name:GO, CHRISTINA ANN (PSYD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ANN
Last Name:GO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3206
Mailing Address - Country:US
Mailing Address - Phone:714-421-2768
Mailing Address - Fax:
Practice Address - Street 1:40 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3206
Practice Address - Country:US
Practice Address - Phone:714-421-2768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical