Provider Demographics
NPI:1235790643
Name:FAY, CHRISTINE (LICSW, LADC I, CADC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FAY
Suffix:
Gender:
Credentials:LICSW, LADC I, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-3309
Mailing Address - Country:US
Mailing Address - Phone:781-474-9423
Mailing Address - Fax:
Practice Address - Street 1:3 ALLIED DR STE 303
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6148
Practice Address - Country:US
Practice Address - Phone:617-221-5131
Practice Address - Fax:781-459-4698
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22943101YA0400X
MA1899AD101YA0400X
MA128678101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)