Provider Demographics
NPI:1174662126
Name:CRELLIN, BARBARA M (LMHC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:M
Last Name:CRELLIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POND ST APT 5
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2759
Mailing Address - Country:US
Mailing Address - Phone:617-522-2804
Mailing Address - Fax:
Practice Address - Street 1:947 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2171
Practice Address - Country:US
Practice Address - Phone:508-375-0609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 4145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health