Provider Demographics
NPI:1073262655
Name:LAWRENCE, CRYSTAL D (ASW)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 RIDGE PARK CT
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-1201
Mailing Address - Country:US
Mailing Address - Phone:609-481-7996
Mailing Address - Fax:
Practice Address - Street 1:5555 E STEARNS ST STE 107
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3164
Practice Address - Country:US
Practice Address - Phone:609-481-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA979931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA97993OtherBOARD OF BEHAVIORAL SCIENCES