Fredric A Kristal, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS925 Issued in ME

Practice address

29 Franklin St
Bangor, ME 04401-4909

Phone

(207) 942-3816

Fax

(207) 561-4725

NPI assigned

Jun 7, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Acadia Hospital Corp

  • Psychiatric Hospital
  • Bangor, ME
  • NPI 1215940523
  Medicare reassignment NPD
• Acadia Healthcare, Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bangor, ME
  • NPI 1568477297
  NPD (past)
• Northeast Occupational Exchange, Inc

  • Psychologist
  • Bangor, ME
  • NPI 1427002138
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1649210865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 FRANKLIN ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044014909",
            "telephone_number": "207-942-3816",
            "fax_number": "207-561-4725"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "735 Wilson St",
            "address_purpose": "LOCATION",
            "city": "Brewer",
            "state": "ME",
            "postal_code": "044121000",
            "country_code": "US",
            "telephone_number": "207-989-1567",
            "fax_number": "207-989-2286",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRISTAL",
        "first_name": "FREDRIC",
        "middle_name": "A",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "ME",
            "license": "PS925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "223490099",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM LEGACY NUMBER",
            "identifier": "098303",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gregory Paul Kramer, D.M.D.
• Joanna Catherine Krasinski, MSN, APRN, BC, COHNS
• Donald W Krause, MD
• Andrew David Kreitzer, PSY.D.
• Kris Sornberger Osteopathic Healthcare
• Agnieszka Karolina Serwik Kronholm, PH.D.
• Victoria Amanda Kugel, LCPC
• Jennie Kuhn, LCPC-C
• Allison Cosslett Kulikowski, DO
• Davina K Kulikowski, LCSW

• Psychologist in Bangor, ME
• Providers in Bangor, ME by specialty
• Psychologist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.