Provider Demographics
NPI:1619565694
Name:POULIN, CHRISTOPHER JAMES (LICSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JAMES
Last Name:POULIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1725
Mailing Address - Country:US
Mailing Address - Phone:508-443-4008
Mailing Address - Fax:
Practice Address - Street 1:4 JUNIPER RD
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1725
Practice Address - Country:US
Practice Address - Phone:508-443-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1619565694101YM0800X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health