Provider Demographics
NPI:1740830728
Name:KOTSIOPOULOS, CRYSTIMARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CRYSTIMARIA
Middle Name:
Last Name:KOTSIOPOULOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CRYSTI
Other - Middle Name:
Other - Last Name:KOTSIOPOULOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:40 NOUVELLE WAY UNIT N848
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-6512
Mailing Address - Country:US
Mailing Address - Phone:781-790-4497
Mailing Address - Fax:781-622-9606
Practice Address - Street 1:4238 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-2558
Practice Address - Country:US
Practice Address - Phone:781-790-4497
Practice Address - Fax:781-622-9606
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSY12726103T00000X
MAPSY10000634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist