Provider Demographics
NPI:1033107263
Name:CRAWFORD, ANNETTE MARIA (MSW,LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:MARIA
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MCCORMACK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GEORGE
Mailing Address - State:NY
Mailing Address - Zip Code:12845-3425
Mailing Address - Country:US
Mailing Address - Phone:518-792-4167
Mailing Address - Fax:518-792-4125
Practice Address - Street 1:98 MCCORMACK DR
Practice Address - Street 2:
Practice Address - City:LAKE GEORGE
Practice Address - State:NY
Practice Address - Zip Code:12845-3425
Practice Address - Country:US
Practice Address - Phone:518-792-4167
Practice Address - Fax:518-792-4125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029866-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000493013001OtherBLUE SHIELD
NYN42151OtherBLUE CROSS
NY52916BMedicare ID - Type Unspecified