Active NPI
Christine Rae Vavak, PH.D.
- Psychologist
- Longmeadow, MA
National Provider Identifier
1497829204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6667
- Practice address
- 666 Bliss Rd
Suite 1
Longmeadow, MA 01106-1562 - Phone
- (413) 567-4515
- Fax
- (413) 567-4515
- NPI assigned
- Nov 20, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6667 | MA | Primary |
Addresses
Primary practice location
666 Bliss Rd
Suite 1
Longmeadow, MA 01106-1562
Mailing address
666 Bliss Rd
Suite 1
Longmeadow, MA 01106-1562
Phone (413) 567-4515
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1858645 | Medicaid | MA | |
| W06188 | Other | MA | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6667 | MA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497829204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "666 BLISS RD",
"address_2": "SUITE 1",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011061562",
"telephone_number": "413-567-4515",
"fax_number": "413-567-4515"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "666 BLISS RD",
"address_2": "SUITE 1",
"city": "LONGMEADOW",
"state": "MA",
"postal_code": "011061562",
"telephone_number": "413-567-4515",
"fax_number": "413-567-4515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAVAK",
"first_name": "CHRISTINE",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MA",
"license": "6667",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1858645",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "W06188",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Longmeadow, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.