Provider Demographics
NPI:1639319197
Name:KRISTOPH, CHERYL PATRICIA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:PATRICIA
Last Name:KRISTOPH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 NORTH MAIN STREET
Mailing Address - Street 2:BROCKTON CATHOLIC CHARITIES
Mailing Address - City:BROCKTON, MA.
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-587-0815
Mailing Address - Fax:508-580-4526
Practice Address - Street 1:152 SYLVAN STREET
Practice Address - Street 2:CATHOLIC CHARITIES
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-774-6820
Practice Address - Fax:978-777-4242
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical