Provider Demographics
NPI:1730245150
Name:KRISHNABAI, UNKNOWN (MSW LICSW)
Entity type:Individual
Prefix:MS
First Name:UNKNOWN
Middle Name:
Last Name:KRISHNABAI
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:ASHBY
Mailing Address - State:MA
Mailing Address - Zip Code:01431-0160
Mailing Address - Country:US
Mailing Address - Phone:978-827-1181
Mailing Address - Fax:978-827-1179
Practice Address - Street 1:20 POND RD
Practice Address - Street 2:
Practice Address - City:ASHBY
Practice Address - State:MA
Practice Address - Zip Code:01431-1733
Practice Address - Country:US
Practice Address - Phone:978-827-1181
Practice Address - Fax:978-827-1179
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110533104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1857622Medicaid
MAP07839OtherBCBS
009650OtherHARVARD PILGRIM
009650OtherHARVARD PILGRIM