Provider Demographics
NPI:1992047542
Name:SMOLENAK, CRISTINA LYN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:LYN
Last Name:SMOLENAK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 LAKESIDE PARK
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4078
Mailing Address - Country:US
Mailing Address - Phone:215-354-0772
Mailing Address - Fax:215-354-0772
Practice Address - Street 1:504 LAKESIDE PARK
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4078
Practice Address - Country:US
Practice Address - Phone:215-354-0772
Practice Address - Fax:215-354-0772
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006850101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional