Provider Demographics
NPI:1174954143
Name:FAYYAD, KRISTYN MARIE
Entity type:Individual
Prefix:
First Name:KRISTYN
Middle Name:MARIE
Last Name:FAYYAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:MARIE
Other - Last Name:CROMIDAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14 PAGE ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2825
Mailing Address - Country:US
Mailing Address - Phone:978-210-7525
Mailing Address - Fax:
Practice Address - Street 1:145 FAUNCE CORNER RD STE K
Practice Address - Street 2:
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1263
Practice Address - Country:US
Practice Address - Phone:774-206-1125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst