Provider Demographics
NPI:1063450450
Name:DENNIS, CRAWFORD GRANBERRY (LISW)
Entity Type:Individual
Prefix:MR
First Name:CRAWFORD
Middle Name:GRANBERRY
Last Name:DENNIS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LAS LOMAS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2634
Mailing Address - Country:US
Mailing Address - Phone:505-246-8700
Mailing Address - Fax:
Practice Address - Street 1:1010 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2634
Practice Address - Country:US
Practice Address - Phone:505-246-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-00411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical